Presentation
Three months of constipation. Sense of lower abdominal/rectal fullness with passage of small amounts of hard stool.
Patient Data
The rectum and distal sigmoid colon are distended by the injected barium with a proximal sigmoid colon (mostly intraluminal) mass with a rounded edge obstructing the flow of barium to descending colon. The mass wasn't dislodged by changing to a decubitus position or rotating the patient.
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The sigmoid mass observed on the barium study is seen in the CT study to be an intraluminal globular mass with a finely corregated surface and internal low density (fat) foci. The proximal bowel is collapsed with no evidence of intestinal obstruction.
Follow-up Barium study after 1 week of laxatives.
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The previously seen intraluminal sigmoid mass is still seen in today's study with the barium reaching the proximal sigmoid colon, confirming the non-obstructing nature of the lesion.
Case Discussion
Taking into consideration the patient's complaint of prolonged constipation and absence of psychiatric illness, this mass is mostly a fecaloma/impacted fecal matter causing constipation.
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