Fecal impaction: a systematic review of its medical complications

Abstract

BackgroundFecal impaction (FI) is a common problem in the elderly and other at-risk groups, such as patients with a neuro-psychiatric disease. It has been associated with medical problems and high morbi-mortality. A systematic review of this topic might be useful to improve the knowledge in this area and helpful to make an appropriate and early diagnosis.MethodsA PubMed systematic search was performed using relevant keywords. Case reports published in English, Spanish or French till June 2014 were included if they had a diagnosis of FI and a medical complication secondary to it. Each case was classified based on its principal complication. The main objective is to create a classification of FI complications based on published clinical cases.Results188 articles met inclusion criteria, comprising 280 clinical cases. Out of the total, 43,5 % were over 65 years old, 49 % suffered from chronic constipation, 29 % had an underlying neuropsychiatric disease and 15 % were hospitalised or institutionalised. A total of 346 medical complications secondary to FI were collected. They were divided according to gastrointestinal tract involvement and then classified based on their anatomical and pathophysiological mechanism into three groups: Complications secondary to fecaloma effect on the intestinal wall (73.4 %), on the intestinal lumen (14 %) and on adjacent structures (12.6 %).ConclusionsFI causes complications that might be fatal. The elderly, underlying neuropsychiatric disease and hospitalised or institutionalised patients integrate the high-risk group in which FI must be suspected. The first FI complications classification is presented to improve the knowledge about this entity.

Chemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging Treatments

“…Constipation can cause a number of significant symptoms. Severely constipated patients experience abdominal distension usually accompanied by severe abrupt episodes of abdominal pain (Falcón et al, 2016). Furthermore, rectal tearing, hemorrhoids and rectal fissures caused by passing hard, dry stool are frequent complications of constipation (Leung et al, 2011).…”

A case of stercoral colitis with marked elevation of serum carcinoembryonic antigen

“…Stercoral colitis is mostly seen in elderly individuals and is more common in old females. It is related to patients being bedridden or having neuropsychiatric disorders, with a poor performance status and a history of chronic constipation along with other comorbidities . Patients with stercoral colitis usually present with abdominal pain and sometimes with distention, nausea, vomiting, melena, or diarrhea .…”

Faecal impaction causing bilateral pelvic venous thrombosis

“…Depending on the setting, the prevalence of FI in the elderly varies from 5 to 8.8% [1], and up to 50% of the institutionalised geriatric patients develop FI in the course of one year [2].…”

“…Despite the fact that FI in most cases is a preventable disease, it remains associated with a significant morbidity and mortality, and has major socio-economic consequences [1,2]. In a systematic review, Serrano Falcon et al recently presented a classification of the medical complications associated with FI [2].…”

“…In a systematic review, Serrano Falcon et al recently presented a classification of the medical complications associated with FI [2]. They propose a subdivision into three groups, with complications secondary to the effect of a faecaloma on the intestinal wall and on the intestinal lumen as the most frequent (73.4% and 14%).…”