This is a case of a patient with a first presentation of constipation and obstructive symptoms with a large fecaloma and stercoral colitis. Although a rare complication of fecal impaction, pressure necrosis may lead to life-threatening fecal peritonitis. This patient was medically managed without further complications, and biopsy confirmation of Hirschprung's disease has not been obtained.

A 2008 study suggested that adult Hirschsprung's disease manifests as a markedly dilated proximal colonic segment with a transition zone and a narrowed distal colonic segment on CT.¹