Presentation
Patient with background of schizophrenia and previous bowel pseudo-obstruction presents acutely confused with profuse diarrhoea. His abdomen was non-tender, but distended with scanty bowel sounds. WBC 18, CRP 114.
Patient Data
Study is limited by lack of intravenous contrast and breathing artefact within the upper abdomen.
The sigmoid colon and rectum is distended and faecal filled with marked wall thickening and surrounding fat stranding.
No intramural gas or free gas is seen. Bowel loops have an otherwise normal appearance.
Case Discussion
Despite limitations of study with lack of intravenous contrast, this patient's CT abdomen and pelvis demonstrates significant bowel wall thickening and fat stranding with associated faecaloma. No bowel perforation was identified and he was managed with placement of a nasogastric tube and aperients. In this individual case, it is suspected the patient's concurrent high dose clozapine had precipitated the severe faecal impaction over the preceding 4 weeks.