Significant Morbidity and Mortality Associated with Fecal Impaction in Patients Who Present to the Emergency Department

Abstract

Background: Fecal impaction (FI) is defined by a large mass of stool in the rectum and/or colon that is unable to be evacuated. No literature to date details demographics and outcomes in a sizeable sample of FI patients in the United States. Aims: The present study aims to develop knowledge of FI by reporting descriptive measures and outcomes of patients presenting to a U.S. emergency department (ED) with FI. Methods: Medical charts coded with FI at Beth Israel Deaconess Medical Center from 2016 or 2017 were identified retrospectively. Patients diagnosed with FI in the ED or subsequent to direct hospital admission from the ED were included. Patient-specific demographics, visit-specific details, medical and medication histories, and hospital treatment and outcome measures were included in a database and analyzed. Results: 32 patients (mean age of 72.9 years, 62.5% female) had a total of 42 ED visits with FI. Patients had an average of 8.7 diagnoses and 11.2 medications listed in their charts. 54.8% of patients were taking at least one commonly prescribed constipating medication. The median total length of stay for admitted patients was 3 days, with nearly 90% of the ED visits with FI requiring hospital admission. 40.6% of patients experienced serious FI-related morbidities, and 21.9% of patients with FI died in the hospital. Conclusion: Patients presenting with FI had high risk of morbidity and mortality, complex medical histories, and large numbers of active treatment regimens. Patients with FI should receive immediate treatment and close monitoring for morbidities and complications.

Spontaneous Recurrent Pneumoperitoneum due to Opioid-Induced Constipation: A Case Report

“…We postulate that stercoral colitis may result in micro-perforation and accumulation of gas and hence manifests as pneumoperitoneum. It is crucial to diagnose and address stercoral colitis and prevent bowel perforation [13][14][15][16].…”

Overflow diarrhea and acute kidney injury as a presentation of fecal impaction that led to obstructive uropathy

“…2 One retrospective article of patients who presented with fecal impaction at Beth Israel Deaconess Medical Center reported that at least 54.8% of these patients were taking at least one commonly prescribed constipation causing medication. 3 In another retrospective study of 130 patients who presented to a tertiary center in Beirut with fecal impaction reported 75.3% had at least one of the following concurrent conditions: heart disease, neurological disease, diabetes, or being bedridden. In over two-thirds of these patients, the site of impaction was the rectum.…”

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

“…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.…”

“…[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. 1,2 Fecaloma is often managed conservatively by manual disimpaction, laxatives and enemas.…”