Bilateral Ureteral Obstruction Caused by a Fecaloma: An Uncommon Presentation of Acute Kidney Injury

Abstract

An 84 year-old woman with a history of hypertension, dyslipidemia, type 2 diabetes, atrial fibrillation, and diabetic kidney disease, presented with anorexia, oligoanuria, and constipation despite laxatives. The physical exam revealed a distended abdomen, and lab tests showed high creatinine levels only. The pre-renal etiology of the acute kidney injury was considered due to anorexia and probable dehydration. However, given the constipation mentioned in the clinical history, it was important to rule out a post-renal cause for the acute kidney injury, so an abdominal and pelvic CT scan was requested. The CT scan revealed small kidneys with ureters compressed by an 8 cm fecaloma, leading to acute renal failure due to post-renal obstruction (Figures 1 and 2). Laxative therapy was initiated, which resolved the fecaloma, and the patient was catheterized, resulting in the immediate release of 1 liter of urine. The resolution of the fecaloma and subsequent post-renal decompression led to a rapid recovery of kidney function.