Spanning the abdominal and pelvic cavities, it has a length of approximately 1.5 meters, almost equal to the height of a fully grown adult! Pediatric gastroenterology, hepatology& nutrition 16: 200-205.The large intestine, also known as the large bowel, represents the last part of the gastrointestinal tract. Park JS, Park TJ, Hwa JS, Seo JH, Park CH, Youn HS (2013) Acute Urinary Retention in a 47-month-old Girl Caused by the Giant Fecaloma.(2013) A stercoral perforation of the rectum. Kwag SJ, Choi SK, Park JH, Jung EJ, Jung CY, et al.Pediatric gastroenterology, hepatology& nutrition 18: 193-196. Yoo HY, Park HW, Chang SH, Bae SH (2015) IlealFecaloma Presenting with Small Bowel Obstruction.(2014) Stercoral colitis: a lethal disease-computed tomographic findings and clinical characteristic. Saksonov M, Bachar GN, Morgenstern S, Zeina AR, Vasserman M, et al.
Aiyappan SK, Ranga U, Samraj A, Rajan SC, Veeraiyan S (2013) A case of fecaloma.(2007) Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, et al.The chronic pseudo-obstruction and low colonic transit in addition to chronic narcotic use in the patient in this case likely predisposed her to chronic fecal impaction and subsequently developing large fecaloma. Surgical removal with limited or more extensive resection is required when conservative management fails to adequately remove fecalomas. Fecaloma may lead to specious diarrhea, bowel obstruction, stercoral colon ulceration and perforation, and urinary tract obstruction and hydronephrosis. The unusual site of the fecal mass at the colonic splenic flexure in this case was initially concerning for malignancy. Fecaloma is the most severe form of fecal impaction in predisposed individuals and mfost commonly found in the recto-sigmoid area as stool becomes more consolidated due to decreased fluid content in the distal colon. Discussionįecaloma is an organized intraluminal fecal mass that is formed secondary to prolonged retention of fecal residue. She was eventually discharged to a rehabilitation institution. A repeat abdominal CT scan showed worsening of the colonic obstruction proximal to the fecal mass with a new transition point.Īfter failed medical and endoscopic management, she underwent surgical removal of the fecal mass, sigmoidectomy with diverting loop ileostomy. Patient received multiple laxative and stool softener regimens without improvement repeat flexible sigmoidoscopy did not reveal any significant change in the size of the fecal mass. Flexible sigmoidoscopy revealed circumferentially obstructive solid fecal mass at the splenic flexure ( Figure 2) with unsuccessful attempts to break it down with snare and forceps.įigure 2: Flexible sigmoidoscopy shows a circumferentially obstructive solid fecal mass at the splenic flexure unsuccessful attempts to break it down with snare and forceps. A contrast-enhanced computed tomography (CT) scan of the abdomen showed diffuse dilatation of the proximal and mid small bowel with decompression of more distal loops it also showed a large 14 cm mixed air and soft tissue density mass in the colonic splenic flexure ( Figure 1b, green arrow). Abdominal examination was notable for left lower quadrant tenderness and a left upper quadrant palpable mass.Ībdominal X-ray showed, in addition to a few air filled dilated bowel loops consistent with partial bowel obstruction, a large mass in the left hemi-abdomen suspicious for malignancy ( Figure 1a, blue arrow). She also reported a history of chronic constipation and narcotics use for her chronic hip pain. Case InformationĪ 56 year-old female with history of irritable bowel syndrome, polymyositis and chronic intestinal pseudo-obstruction (on chronic total parenteral nutrition) presented with 2-week duration of left lower quadrant abdominal pain, nausea, vomiting, and diarrhea (dark green stools). We report a case of large bowel obstruction secondary to a large fecal mass at an unusual place at the colonic splenic flexure that was initially concerning for malignancy. Chronic functional bowel obstruction can lead to fecal impaction and subsequent fecaloma formation. Large bowel obstruction is less common that small bowel obstruction and constitutes about 25% of intestinal obstruction. Splenic flexure Fecaloma Constipation Introduction
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