Presentation
3-hour history of lower abdominal pain in a patient with gallstones.
Patient Data
Very large colonic stool burden with a large rectal stool ball in the rectal vault with associated rectal wall thickening and minimal stranding. Stool ball measures approximately 8.0 x 7.2 cm. Findings are suggestive of constipation/possible impaction with associated stercoral colitis.
Multiple large gallstones with mild gallbladder wall thickening. There is prominent dilatation of the common bile duct measuring up to 1.2 cm in diameter.
Case Discussion
Fecal impaction (FI) represents a common problem in the elderly population 1. It is a cause of significant morbidity with associated decrease in quality of life, particularly, in older patients. Impaction occurs due to hardened fecal matter in the large bowel which cannot be relieved through regular peristaltic activity. Risk factors for the condition include medications (such as opioids, and anticholinergics), prior surgical history, congenital anomalies, and generalized disorders such as scleroderma and end-stage renal disease. There is also an increase in incidence of FI in elderly patients taking NSAIDs 1. Complications include stercoraceous colitis, fistula, incontinence, megacolon and obstruction 2.
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