Fecal material

Fecal material
	Diagnosis in short
	; A food particle and a tubular adenoma. H&E stain.
LM	plant matter - has cell walls, meat - skeletal muscle without nuclei, microorganisms (bacilli, cocci), +/-colorectal mucosa
LM DDx	necrosis
Gross	soft material, amorphous, friable
Site	cecum, colon, rectum
Clinical history	poor bowel preparation
Prevalence	relatively common
Endoscopy	polypoid lesion
Prognosis	benign
Clin. DDx	gastrointestinal polyp

Fecal material, also fecal matter, is poo. It is seen in gastrointestinal pathology.

General

Common.
Associated with poor bowel preparation.
- People on a low-fibre diet seem to have less of 'em.^[1]
Endoscopists go after anything that is polypoid and that may be nothing more than poo.

Gross

Soft amorphous material.
+/-Friable.

DDx:

Colonic cast - membranous appearance; described as airbladder of fish-like.^[2]
- Arises in colonic ischemia^[3] - typically post-AAA repair or after colorectal surgery.^[4]

Microscopic

Features:

Plant material:
- Yellow staining chicken wire-like material - may be linear.
  - Thick cell walls often without cytoplasm and usually without a nucleus.
Meat:
- Essentially ischemic skeletal muscle without inflammation.
  - Eosinophilic material without nuclei and without inflammation.
    - Honeycomb-like when fibres seen in cross-section.
+/-Microorganisms.
+/-Inflammatory cells.

DDx:

Images

Anucleate striated muscle - intermed. mag.
Anucleate striated muscle - high mag.
Anucleate striated muscle - high mag.
Anucleate striated muscle - extremely high mag.

TA and plant material - intermed. mag.
TA and plant material - high mag.
Plant material - very high mag.

Sign out

Often ignored if colorectal mucosa is present.

TRANSVERSE COLON, BIOPSY:
- FECAL MATERIAL.
- NO DEFINITE COLONIC MUCOSA IDENTIFIED.

Alternate

ASCENDING COLON ("POLYP"), REMOVAL:
- CONSISTENT WITH PARTIALLY DIGESTED FOOD.
- NO DEFINITE COLONIC MUCOSA IDENTIFIED.

Micro

The sections show a fragment of striated muscle without nuclei and without inflammation, with scant microorganisms. No colorectal mucosa is identified.

Rectum

RECTUM, BIOPSY:
- FECAL MATERIAL.
- NO DEFINITE RECTAL MUCOSA IDENTIFIED.

References

↑ Liedenbaum, MH.; Denters, MJ.; de Vries, AH.; van Ravesteijn, VF.; Bipat, S.; Vos, FM.; Dekker, E.; Stoker, J. (Jul 2010). "Low-fiber diet in limited bowel preparation for CT colonography: Influence on image quality and patient acceptance.". AJR Am J Roentgenol 195 (1): W31-7. doi:10.2214/AJR.09.3572. PMID 20566777.
↑ Yoshiji, H.; Nakae, D.; Sugiya, R.; Mizumoto, Y.; Tsutsumi, M.; Hiriguchi, K.; Yokose, Y.; Sakurai, R. et al. (Feb 1994). "Spontaneous passage of a colon cast in the absence of abdominal aneurysm.". J Gastroenterol 29 (1): 80-3. PMID 8199700.
↑ Abe, S.; Yamaguchi, H.; Murono, K.; Kanazawa, T.; Ishihara, S.; Sunami, E.; Watanabe, T.. "Passage of a sigmoid colon cast in a patient with ischemic colitis.". Int Surg 99 (5): 500-5. doi:10.9738/INTSURG-D-14-00066.1. PMID 25216411.
↑ Erguney, S.; Yavuz, N.; Ersoy, YE.; Teksoz, S.; Selcuk, D.; Ogut, G.; Dogusoy, G.; Alver, O. (Aug 2007). "Passage of "colonic cast" after colorectal surgery: report of four cases and review of the literature.". J Gastrointest Surg 11 (8): 1045-51. doi:10.1007/s11605-007-0194-z. PMID 17564753.

[pmid20566777-1] Liedenbaum, MH.; Denters, MJ.; de Vries, AH.; van Ravesteijn, VF.; Bipat, S.; Vos, FM.; Dekker, E.; Stoker, J. (Jul 2010). "Low-fiber diet in limited bowel preparation for CT colonography: Influence on image quality and patient acceptance.". AJR Am J Roentgenol 195 (1): W31-7. doi:10.2214/AJR.09.3572. PMID 20566777.

[pmid8199700-2] Yoshiji, H.; Nakae, D.; Sugiya, R.; Mizumoto, Y.; Tsutsumi, M.; Hiriguchi, K.; Yokose, Y.; Sakurai, R. et al. (Feb 1994). "Spontaneous passage of a colon cast in the absence of abdominal aneurysm.". J Gastroenterol 29 (1): 80-3. PMID 8199700.

[pmid25216411-3] Abe, S.; Yamaguchi, H.; Murono, K.; Kanazawa, T.; Ishihara, S.; Sunami, E.; Watanabe, T.. "Passage of a sigmoid colon cast in a patient with ischemic colitis.". Int Surg 99 (5): 500-5. doi:10.9738/INTSURG-D-14-00066.1. PMID 25216411.

[pmid17564753-4] Erguney, S.; Yavuz, N.; Ersoy, YE.; Teksoz, S.; Selcuk, D.; Ogut, G.; Dogusoy, G.; Alver, O. (Aug 2007). "Passage of "colonic cast" after colorectal surgery: report of four cases and review of the literature.". J Gastrointest Surg 11 (8): 1045-51. doi:10.1007/s11605-007-0194-z. PMID 17564753.

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