Presentation
Constipation.
Patient Data
Dolichocolon is noted with a large fecal mass filling the descending colon, sigmoid and rectum, with associated diffuse bowel wall thickening, in keeping with fecaloma with possibility of associated stercoral colitis.
No signs of perforation. Retained gases and fecal matter at rest of proximal colon.
The uterus and urinary bladder are displaced and compressed anterior to the rectal mass.
Bilateral inguinal inflammatory lymph nodes.
Case Discussion
Fecaloma occurs in the young and elderly. It is due to the accumulation of hard stools forming an intraluminal mass and is considered a type of large bowel obstruction. Management consists of enemas for softening the stool and lubricating its passage and in certain cases, manual evacuation as well. In some patients, surgery is required if medical treatment fails. Prevention of further episodes of fecal impaction consists of increasing fluid intake and dietary fibers, regular exercise (if tolerated), and replacing opioid medications to the extent possible.
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