INTRODUCTION: Faecal concretions or faecalomas ('stone of faeces') are symptomatic of many well-recognised colorectal conditions. Faecalomas are usually located in the colon or rectum and associated with disorders of colorectal transit. We describe an unusual case of 'faecaloma in ano' secondary to a chronic fissure in ano. A 67-year-old woman with a 10-year history of chronic constipation and intermittent anal discomfort presented with a painless perianal lump of similar duration. METHODS: The patient's case notes were reviewed and a literature search was carried out. RESULTS: Examination under anaesthesia, sigmoidoscopy and anoscopy did not reveal any mucosal abnormality or an internal opening or any connection with the perianal lump. The mass was enucleated after incising the skin, leaving behind a cavity completely separate from the anal canal and sphincters. Histology revealed inspissated faecal material with evidence of calcification. CONCLUSIONS: Chronic fissures may be complicated by sepsis and, rarely, a 'fissure fistula' may develop. We suspect that this was the underlying pathogenesis of this 'faecaloma in ano'. The term faecaloma in ano befits the clinical picture.
INTRODUCTION: Faecal concretions or faecalomas ('stone of faeces') are symptomatic of many well-recognised colorectal conditions. Faecalomas are usually located in the colon or rectum and associated with disorders of colorectal transit. We describe an unusual case of 'faecaloma in ano' secondary to a chronic fissure in ano. A 67-year-old woman with a 10-year history of chronic constipation and intermittent anal discomfort presented with a painless perianal lump of similar duration. METHODS: The patient's case notes were reviewed and a literature search was carried out. RESULTS: Examination under anaesthesia, sigmoidoscopy and anoscopy did not reveal any mucosal abnormality or an internal opening or any connection with the perianal lump. The mass was enucleated after incising the skin, leaving behind a cavity completely separate from the anal canal and sphincters. Histology revealed inspissated faecal material with evidence of calcification. CONCLUSIONS: Chronic fissures may be complicated by sepsis and, rarely, a 'fissure fistula' may develop. We suspect that this was the underlying pathogenesis of this 'faecaloma in ano'. The term faecaloma in ano befits the clinical picture.