Fecaloma Complicating Colostomy for Hirschprung Disease

Abstract

Abstract Background Hirschprung disease (HD) is a congenital disorder characterized by absence of ganglion cells in the distal portion of the large intestine with resultant obstruction. It commonly manifests shortly after birth, hence its usual diagnosis in the first year of life. A defunctioning colostomy precedes definitive treatment. Prolonged obstruction following untreated HD or any condition may progressively lead to fecaloma, a mass of inspissated feces commonly in the rectosigmoid that is much harder than impacted feces. If prolonged, affected intestine looks like a tumor. We present a case of fecaloma of the transverse colon complicating colostomy done for Hirschprung disease. Case Report A 6-year-old boy with a 6-year history of difficulty with passing stool with progressive abdominal swelling had Swenson’s procedure (ie, proctectomy) and prolapsing of ganglionic colon to the anus with left hemicolectomy. He had presented to the pediatric surgery unit of our hospital 4 years previously with these symptoms with a defunctioning colostomy performed for suspected HD. He reportedly passed meconium a day after birth and subsequently passed stool once in 7 to 14 days spontaneously or after digital manipulations. Stooling frequency progressively reduced but no vomiting. Following administration of herbs, he developed diarrhea, and with worsening symptoms, he presented to our hospital. Three years postcolostomy, rectal biopsy was performed with a histology confirming aganglionosis of the rectum (HD). Barium enema had shown long-segment HD with dilated rectosigmoid colon but no fecaloma. Surgical specimen received in the histopathology laboratory consisted of colon segment comprising a colostomy stump with a ring of skin (colostomy stoma) and a proximal markedly dilated portion filled with fecaloma followed by a hypertrophied proximal portion. Histology showed presence of ganglion cells in these segments. Conclusion Fecaloma should be suspected in a protracted colostomy with abdominal mass proximal to the stoma.