Fecaloma: Classification, Treatment, and Outcomes

Abstract

Abstract Background: Fecaloma is a mass of hardened and impacted feces. Its prevalence is high in elderly individuals and patients with neuromuscular changes in the gastrointestinal tract. Objectives: The purpose of this study was to analyze the causes, treatment, and outcomes of fecal impaction in a large group of patients. Design: This study was a cross-sectional, observational, retrospective study. Setting: Núcleo de Estudo de Doença de Chagas (Refering Center for Chagas disease), Hospital das Clínicas, Universidade Federal de Goiás, Goiania, Brazil. Patients and Methods: The records of patients referred to perform serology for Chagas disease with a history of fecal impaction were analyzed. Demographic data, causes, extension of fecal mass, complication (volvulus and bowel perforation), type of treatment, and outcomes were obtained. Main Outcomes and Measurements: Differences between two groups of patients with fecaloma: chagasic megacolon and normal population. Sample Size: A total of 1054 patients were included. Results: The median age of the patients was 64 years, with higher prevalence in women at 56.8%, and serology for Chagas disease was positive in 80.3%. Constipation was reported in 80.3% and the use of laxatives in 59.7%. The most prevalent location of fecaloma was in the rectosigmoid (64%), and the most associated complication was volvulus (11%). Most patients were managed with conservative treatment (71.1%), and surgical intervention (28.9%) was needed in complicated patients. Conclusion: Most patients with fecaloma were elderly women and the main cause was Chagas disease. Constipation and the rate of laxative use were significant in this population. Conservative approach resolves most cases. Surgery may be indicated in refractory cases and in cases of volvulus or bowel perforation. Limitations: This is a retrospective study, and many patients do not have an adequate follow-up file. Colonic evaluation is limited by poor clinical condition and age. Barium enema exam may overestimate colorectal dilation due to its methodology. Conflict of Interest: The authors have no conflict of interest to declare.