Fecaloma presenting as huge abdominal mass

Khan, Mushtaq Ahmad; Dar, Hilal Ahmad; Shah, Altaf; Javid, Gul; Singh, Bhagat; Sheikh, Nadeem Ahmad; Ashraf, Aadil

doi:10.1002/jgh3.12221

Cited by 6 publications

(9 citation statements)

References 7 publications

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“…[12][13][14] Moreover, patients with schizoaffective disorders who are receiving antipsychotic, anticholinergic, tricyclic antidepressant, and antiserotonergic medication are also at a higher risk. [12][13][14][15] Consistent with these reports, our patient was also bedridden owing to a previous cerebral infarction and femur fracture; she also had a history of chronic constipation. Moreover, her medical records confirmed that the patient had been taking analgesics for the femur fracture.…”

Section: Discussionsupporting

confidence: 86%

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Acute Hydronephrosis owing to A Giant Fecaloma in an Older Patient

Joo

Lee

2020

Ann Geriatr Med Res

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Acute urinary tract obstruction can cause acute kidney damage and urinary tract infections, which can lead to potentially fatal complications. Although rare, acute urinary tract obstruction can be caused by compression of the gastrointestinal (GI) tract. Some cases of acute urinary tract obstruction by giant fecalomas caused by chronic constipation have been reported in patients with immobility and dehydration. 1) In addition, constipation and fecal impaction are common clinical problems in older adults. 2) Even with its clinical relevance, chronic constipation is rarely suspected as a predisposing cause of urinary tract obstruction. To date, there have been no reports of fecaloma-related acute hydronephrosis owing to chronic constipation in Korea. Here, we report a case of acute hydronephrosis owing to a giant fecaloma in an older patient. CASE REPORT An 83-year-old woman with a fever presented to the emergency room. She had a 10-year history of chronic constipation and was in a Hydroureteronephrosis with acute urinary tract obstruction can lead to serious complications such as obstructive nephropathy or pyelonephritis. We report the first case of hydroureteronephrosis caused by a giant fecaloma in an 83-year-old woman accompanied with chronic constipation in Korea. The patient with a fever presented to the emergency room and was diagnosed with right hydronephrosis. Computed tomography revealed a markedly dilated rectum with a giant fecaloma compressing the right vesicoureteric junction. Hydroureteronephrosis was resolved through manual disimpaction of the fecaloma and simultaneous lavage with rectal tubes, which improved the acute pyelonephritis and renal function. Chronic constipation can lead to giant fecaloma threatening urinary tract patency, especially in older patients with immobility or dehydration. Therefore, clinicians should consider this condition as a rare but possible cause of hydronephrosis in older patients with chronic constipation.

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Section: Discussionsupporting

confidence: 86%

“…19,20) Surgery is required only in severe cases. 15) Fortunately, conservative treatment with rectal enema and digital evacuation was successful in our patient.…”

Section: Discussionmentioning

confidence: 57%

Acute Hydronephrosis owing to A Giant Fecaloma in an Older Patient

Joo

Lee

2020

Ann Geriatr Med Res

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“…[3][4][5] Fecaloma can be also be revealed by rectal bleeding, urinary retention and respiratory insufficiency, febrile status, impaired consciousness, altered general condition 7,13,14 Physical examination can demonstrate an abdominal distension, tenderness or mass on palpation and a hard mass in the rectum in digital rectal examination. 7,10,14 In our case, respiratory signs including hypoxemia and pneumonia were the predominant features. The fecaloma was also responsible of urinary retention with renal failure.…”

Section: Discussionmentioning

confidence: 46%

“…[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. 2,4,7 The fecaloma's symptoms are various and non-specific.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Fecaloma is an accumulation of hardened impacted stool typically occurring in the sigmoid colon and rectum. It mainly affects elderly and bedridden patients suffering from chronic constipation and can be revealed by different signs. We report a case of 74-year-old female, with anorexia, Alzheimer’s disease, and chronic constipation, who was admitted to the emergency department with complaints of dyspnea and anuria. Clinical examination showed fever, Glasgow Coma Scale score of 13/15, tachycardia with a blood pressure of 100/50 mmHg, polypnea with hypoxia, foci of crepitant rales in pulmonary auscultation and a tender hypogastric mass with mild diffuse abdominal tenderness. Digital rectal examination revealed hard fecal material. Computed tomography (CT) images demonstrated bilateral pulmonary parenchymal condensation and a huge heterogeneous fecaloma in the sigmoid colon and rectum compressing the bladder. Based on these findings, the diagnosis of giant fecaloma causing aspiration pneumonia and urinary retention was retained. Manual disimpaction and bowel enemas were done but they were unsuccessful and surgical treatment was refused. Ultimately the patient died due to septic shock. Early diagnosis should be made to relieve symptoms and prevent complications.

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“…Fecaloma has varied presentations. Some of the presentations are abdominal mass, stercoral colitis, urinary retention and intestinal obstruction [1] , [5] , [6] , [7] . A systematic review of complications of fecal impaction showed that intestinal obstruction accounts for 13%, while 67% were complications on intestinal wall like perforation, stercoral ulcer [8] .…”

Section: Discussionmentioning

confidence: 99%

Ileal fecalomas causing small bowel obstruction: A case report

Tiruneh

Merine

Solomon

2021

International Journal of Surgery Case Reports

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Introduction Fecaloma is an accumulation of feces that has formed a mass and has failed to be expelled spontaneously. Because fecal matter is harder and firmer in the left side of colon, and the diameter of the bowel is smaller compared to the right, fecalomas mostly form in recto-sigmoid area. Small bowel fecaloma formation is an extremely rare condition. Case presentation We report a 49 years old man who presented with small bowel obstruction due to ileal fecalomas for whom enterotomy and removal of fecaloma was done with good outcome. Discussion Fecal matter can accumulate in the intestinal lumen to form a mass separate from other intestinal contents which eventually becomes fecaloma. Formation is usually related to chronic constipation, conditions causing intestinal motility disorder, or in psychiatric patients who could have ingested extraordinary substances. Fecaloma can present as abdominal mass, stercoral colitis, urinary retention or intestinal obstruction. Treatment options include conservative management with bowel rest, laxatives, endoscopic removal, laparotomy and removal via enterotomy. Conclusion Fecaloma can be considered in patients who present with small bowel obstruction without any risk factors. Initial noninvasive management should be considered. Failed conservative treatment can be followed by laparotomy and fecaloma removal.

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Fecaloma presenting as huge abdominal mass

Cited by 6 publications

References 7 publications

Acute Hydronephrosis owing to A Giant Fecaloma in an Older Patient

Acute Hydronephrosis owing to A Giant Fecaloma in an Older Patient

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

Ileal fecalomas causing small bowel obstruction: A case report

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