Presentation
An elderly female patient (often bedbound) complained of non-specific abdominal symptoms, including chronic constipation, overflow diarrhea and abdominal pain.
Patient Data
Findings:
Distended rectum by a mass of impacted fecal matter (a fecaloma) with asymmetric circumferential wall thickening measuring about 7 mm, mucosal discontinuity and perirectal fatty stranding suggestive of stercoral colitis for clinical correlation. Within normal limits the rest visualized bowel loops.
Normal appearance of liver, GB, CBD, pancreas, spleen, adrenals, kidneys and urinary bladder.
Average size uterus with a well defined heterogeneous fatty component lesion seen in the anterior fundal wall measuring 12x17 mm uterine lipoleiomyoma more likely diagnoses rather than a uterine lipoma.
No significant lymphadenopathy is detected.
No free fluid/air or localized collection is detected.
Atherosclerotic changes of the abdominal aorta.
Both lung bases are clear.
The visualized parts of the bones show no evidence of destructive lesion .lumbar spondylosis.
Impression:
CT found the presence of impacted fecal matter in the lumen of the distended rectal colonic segment associated with inflammation, keeping with stercoral colitis for clinical correlation and further assessment accordingly.
Other findings as mentioned above.
Case Discussion
This patient presented with typical presentations with a history of bed-bound, non-specific abdominal pain, chronic constipation, overflow diarrhea and is used to enema to dis-impaction. CT showed typical radiological findings of large fecaloma with stercoral colitis. The patient was medically managed without further complications. A serious uncommon complication is related to fecaloma is stercoral perforation and fecal peritonitis.
Case courtesy: Dr Sameh Salah and Dr Safwat Almoghazi
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