Severe fecal impaction with stercoral colitis
Sudden onset of pain radiating to right iliac fossa. Associated nausea and vomiting.
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Large volume of fecal 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.
This is a case of a patient with a first presentation of constipation and obstructive symptoms with a large fecaloma and stercoral colitis. Although a rare complication of fecal impaction, pressure necrosis may lead to life-threatening fecal 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