Presentation
Patient was referred from the neuropsychiatry / social affairs department, a spastic quadriplegic (cerebral palsy) with increasing abdominal distension for evaluation.
Patient Data
Gas filled small and large bowel loops.
The large bowel loops appear distended and air filled up to the sigmoid colon wherein the air column is cut off in the pelvis.
No abnormal radiodensities seen.
Overtly distended large bowel secondary to a large volume of feces impacted within the distal sigmoid and rectum. There is secondary mild reactionary perirectal fluid. No definite rectal wall breach or free intra abdominal air identified. The small bowel loops are collapsed.
Nasogastric tube in situ. A rectal tube also seen in situ to facilitate stool evacuation.
Case Discussion
Untreated chronic constipation is a problem frequently encountered in the pediatric and elderly population. Another subset of population that is dearly affected by it are neuropsychiatric patients. The lack of fiber diet and oral water intake and resulting chronic constipation leads to fecal impaction. This is a differential that has to be considered high up in this sector of the population.
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