Obstructive Fecalomas in an Infant Treated with Successful Endoscopic Disimpaction

Abstract

A fecaloma is a mass of accumulated feces with a consistency much harder than that of a fecal impaction. It is most frequently observed in the rectum and sigmoid area, and associated complications include colonic obstruction, ulceration, bleeding, and perforation. A one-year-old, previously healthy boy with no history of chronic constipation was admitted because of vomiting and abdominal distension. An abdominal computed tomography scan showed small and large bowel distension due to multiple obstructive fecalomas in the transverse colon. As the fecalomas could not be resolved by laxatives, enemas, or colonic lavage, endoscopic disimpaction under general anesthesia was attempted. Repeatedly shaving the fecalomas with biopsy forceps finally resulted in gradual fragmentation with subsequent passage. Gastrointestinal food allergy was later suggested as the cause because eosinophilic infiltration was found in a biopsy specimen of the colon wall. Endoscopic disimpaction is an effective treatment approach for addressing fecalomas to avoid more invasive surgical intervention.

Fecalomas as a rare cause of ileus

“…If obstruction develops in a patient with chronic constipation, fecaloma should be considered in the differential diagnosis [4]. In addition, complications such as intestinal perforation, ulceration of the intestinal wall, urinary obstruction, secondary hydronephrosis, deep vein thrombosis and toxic megacolon have been reported [1][2][3][4][5]7].…”

“…They often cannot be expelled spontaneously. Although most of the reported cases are adults, there are cases reported in the pediatric age and even infancy [1][2][3][4].…”

“…Fecalomas often accompany pathologies that cause chronic constipation and motolite disturbance, such as Hirschsprung's disease, Chagas disease, scleroderma, intestinal tuberculosis, inflammatory or tumoral pathologies of the intestine. It can also be observed in psychiatric patients who swallow different substances [1][2][3][4][5][6][7]. It has been reported that intestinal edema or obstruction due to gastrointestinal food allergies may lead to the formation of fecaloma [1,2].…”

“…It can also be observed in psychiatric patients who swallow different substances [1][2][3][4][5][6][7]. It has been reported that intestinal edema or obstruction due to gastrointestinal food allergies may lead to the formation of fecaloma [1,2]. Cases of cerebral palsy, diabetic nephropathy, and fecaloma have also been reported in patients receiving anti-psychotic therapy [8][9][10].…”

“…Very rarely, it can occur without a predisposing factor. Fecalomas are most frequently observed (90%) in the rectum and sigmoid colon because the diameter of the colon is narrower and the stool here is more solid [1,2,4,5]. Rarely, cases of fecaolaoma in the cecum and small intestine have been reported [4].…”