Fecaloma impaction and stercoral ulcer

Abstract

A 76‐year‐old female with a history of chronic constipation presented with progressive abdominal pain and blood‐tinged stools at the emergency room. Upon examination, the computed tomography scan revealed bowel obstruction by a huge fecaloma impaction (9 × 7 cm) with focal thickening of the colonic wall and mural enhancement over the rectum. After gently evacuating feces manually followed by enema, subsequent colonoscopy also confirmed a large stercoral ulcer (6 × 5 cm) over the rectum with diffusely edematous and friable, sloughing mucosa. With conservative treatment, her symptoms were relieved uneventfully. Her condition improved and she was discharged after receiving education about constipation management. Constipation in the elderly population is common. However, in this instance, if left untreated, massive ulcer bleeding or perforation could occur. Therefore, such cases should be evaluated with more caution in order to prevent the development of irreversible complications.

Case Report: A giant fecaloma revealed by severe aspiration pneumonia and urinary retention

“…6,7 Fecaloma is typically seen in elderly patients, particularly in those bed bound and institutionalized and more common in women. [3][4][5] Chronic constipation, frequently seen in elderly and bedridden patients, plays an important role in the development of fecaloma 1,3,4,8 Other common risk factors reported in the literature were neuropsychiatric diseases and use of constipating medication like antiepileptic, antidepressant and opioid therapy. 1,2,7,[9][10][11][12] Fecaloma was also associated with Chagas disease, Hirschsprung's disease, inflammatory and neoplastic diseases, scleroderma, diabetic neuropathy, and anorectal malformations.…”

“…Fecaloma diagnosis is made radiologically through X-rays, barium enema, abdominal ultrasound, or abdominal CT scans. 1,2 Complications associated with fecal impaction are estimated at 40.6% of cases. 3 Some of these complications can be life threatening.…”

“…3 Some of these complications can be life threatening. 7,14 Colonic complications, secondary to the effect of the fecaloma on the intestinal wall or lumen, leads to several injuries like bowel obstruction, 2,15 Intussusception, 16 stercoral ulcer, 1,11 stercoral colitis 8 or toxic megacolon leading to colonic perforation and fecal peritonitis and bleeding 2,3,7 Otherwise, the fecal mass can compress adjacent anatomical structures and lead to hydronephrosis, 12,14,17 nerve compression and deep vein thrombosis. The fecaloma's management is sometimes challenging.…”

“…Fecaloma, a rare cause of fecal impaction, is an accumulation of hardened impacted stool typically occurring in the sigmoid colon and rectum and affecting, especially, elderly patients. [1][2][3][4][5] Symptoms of fecaloma are non-specific, dominated by constipation, abdominal pain, abdominal distention, nausea and vomiting. [3][4][5] The diagnosis is made through abdominal computed tomography scan (CT scan), X-rays or abdominal ultrasound.…”

“…[3][4][5] The diagnosis is made through abdominal computed tomography scan (CT scan), X-rays or abdominal ultrasound. 1,2 Fecaloma is often managed conservatively by manual disimpaction, laxatives and enemas. However, endoscopic or surgical interventions may be mandatory especially when it is refractory to conservative treatment or complicated.…”