Association between the appendix and the fecalith in adults

It is generally accepted that the main etiology of appendicitis is obstruction due to fecalith in adults and lymphoid hyperplasia in children. It is also accepted that perforated/gangrenous appendicitis is associated with an obstructed appendix secondary to the presence of a fecalith. A standard PubMed search on the topic reveals a plethora of literature on appendiceal fecaliths or coproliths. There are many associated articles documenting fecalith rates ranging from 1.5% to 51%, but certainly no level I evidence on the topic. Trinidad & Tobago is a twin island state located off the northern tip of South America and Venezuela; the islands are the southern-most islands in the Caribbean. The population is diverse owing to a history of invasion by Spain, Portugal, France and Britain and to migration from India, Africa, China, Syria and Lebanon as well as other Arabic nations and Amerindian areas. The composition of the population is estimated as follows: East Indian descent (37%), Afro-Caribbean (36%), mixed races (24%) and white, Arabic, Chinese and Amerindian (3%). We present our data on fecalith rates and acute appendicitis in this population.