Severe faecal impaction with stercoral colitis

Case contributed by Dr Edward Zhong

Presentation

Sudden onset of pain radiating to right iliac fossa. Associated nausea and vomiting.

Patient Data

Age: 55 years
Gender: Male

Large volume of faecal material is distending the rectum and sigmoid, with thickening of the wall of the rectum and loss of clear fat planes around the distended rectum. The maximal diameter of the rectum is 13 x 12cm, and it extends superior-inferior diameter of 23cm.

Considering the extent of involvement, consideration should be given to adult Hirschsprung's disease.

Case Discussion

This is a case of a patient with a first presentation of constipation and obstructive symptoms with a large faecaloma and stercoral colitis. Although a rare complication of faecal impaction, pressure necrosis may lead to life-threatening faecal 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

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Case information

rID: 52775
Case created: 20th Apr 2017
Last edited: 1st May 2017
Inclusion in quiz mode: Included

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