Diverticular fecalith in scleroderma simulating colonic neoplasm

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Abstract
This is a report of a patient with the CRST syndrome, a mild variant of scleroderma consisting of calcinosis, Raynaud's phenomenon, sclerodactyly, and telangiectasia. Typical changes of scleroderma were present in the extremities, esophagus, duodenum and colon. In addition, there was a polypoid filling defect in a colonic diverticulum due to a fecalith. The radiologic appearance at first resembled a colonic neoplasm, although its location within a diverticulum and its speckled appearance suggested the possibility of a fecalith. This was confirmed at colonoscopy, which disclosed numerous wide-mouthed diverticula, with inspissated fecal material projecting from several diverticula. In patients with scleroderma and polypoid filling defects in the colon, the possibility of a fecalith within a diverticulum should be considered. Where the radiologic study is inconclusive, colonoscopy may provide a definitive diagnosis.

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