Successful Resolution of Fecal Impaction During Endoscopy Using a Looped Guidewire

Abstract

Fecal impaction is the impaired excretion of a large fecal mass, and mild cases are treated by enema and osmotic laxatives. However, treatment-resistant cases need more invasive alternatives. A woman in her 60s presented with abdominal discomfort. Her abdomen was soft and without tenderness. Computed tomography revealed a large mass of feces in her sigmoid colon and no intestinal dilatation proximal to the mass. Endoscopy confirmed a fecal mass occupying the lumen. A glycerin enema, oral administration of polyethylene glycol, and enteral administration of amidotrizoic acid during colonoscopy were ineffective. We maneuvered a guidewire to form a loop at the tip of an endoscope, with which we subdivided the mass for successful removal. The patient's abdominal discomfort disappeared immediately. Endoscopic disimpaction is far less invasive than surgery and should be considered when treating fecal impaction cases, without severe obstructive colitis, which are nonresponsive to conservative treatment.

A new medical device applied in a case of acute fecal impaction with overflow diarrhea: a case report

“…However, manual disimpaction may cause damage to the anal sphincter and contaminate the environment, while other methods, such as enema, suppositories, and polyethylene glycol solution, can lead to side effects and high risks of falls and cardiovascular accidents in elderly patients [ 16 ]. In severe cases, endoscopy and surgery may be necessary, but successful removal of impaction may also be accompanied by serious complications, including bleeding and perforation [ 8 – 10 ]. It is important to carefully consider the best treatment approach on the basis of the individual patient’s needs and condition.…”

“…The device does not directly contact the intestinal mucosa, which reduces the risk of bleeding and perforation. However, using endoscopic therapy carries the risk of bleeding and perforation for patients with FI [ 8 , 9 ]. Secondly, the Disimpactioner allows patients to comfortably lie in a lateral position on the bed during treatment, without the need for repeated trips to the bathroom or forceful defecation.…”

“…In mild cases, enema and osmotic laxatives, such as polyethylene glycol, are effective treatments; however, in severe or treatment-resistant cases, more invasive alternatives may be required [ 1 , 8 – 10 ]. For elderly patients, surgery may cause further damage.…”

Ultrasonographic Evaluation of Large-Bowel Obstruction With Fecal Impaction: A Case Report

“…However, in severe cases, more invasive alternatives, such as surgery or endoscopy may be required. 12…”

Fecal impaction in adults

“…Repeat this procedure until the rectum is cleared. In rare cases, a colonoscope with a snare or looped guidewire may be used to fragment fecal material in the distal colon 12…”