Fecaloma

Case contributed by Dr Mostafa El-Feky

Presentation

Abdominal distension and absolute constipation.

Patient Data

Age: 65 years
Gender: Female
CT

The rectum and sigmoid are loaded with fecal matter with diffuse thickened wall and proximal colonic gaseous distension.

Diffuse truncal subcutaneous edema is noted.

Left renal lower pole solid mass lesion, recommended for assessment with contrast-enhanced CT exam.

Right renal lower pole cyst.

Atherosclerotic changes with arterial wall calcifications are seen involving aorta, superior and inferior mesenteric arteries, celiac trunk, splenic and gastroduodenal arteries.

The scanned lower chest revealed an enlarged heart with coronary artery stents and bilateral pleural effusion.

Case Discussion

Features are in keeping with fecaloma with stercoral colitis. It is an uncommon complication of chronic constipation that affects both extremes of age. Impacted fecal mass makes mass effect upon the walls of the rectum and sigmoid decreasing their blood supply and causing colitis that can lead to ulceration and perforation. CT is the modality of choice for diagnosis. Urgent surgical assessment with decompression of the colon can prevent stercoral perforation, the more serious complication.

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