FECALOME GEANT A PROPOS D’UNE OBSERVATION ET REVUE DE LA LITTERATURE A L’HOPITAL DONKA

Abstract

Fecal impaction is a mass of hardened fecal matter impacted primarily in the rectum and sigmoid. The most common sites of fecal impaction are the sigmoid colon and the rectum. We report a case of giant ileocecal fecal impaction causing OIA which was treated surgically. Case report: 25-year-old patient, student, admitted to the department for progressive abdominal pain accompanied by cessation of materials and gases, and abdominal bloating lasting for two (2) weeks. As a history, we noted stubborn constipation and episodes of subocclusion. The clinical examination noted a deterioration in general condition WHO stage I, conjunctival hypocoloration, polypnea at 35 cycles/mm and tachycardia at 100/min. The abdomen was very distended and tympanic, intestinal peristalsis was inaudible. Rectal examination revealed vacuity of the rectal bulb. The diagnosis of OIA/VCP was made; the unprepared abdominal X-ray showed aerocolia; biological examination, normochromic and normocytic anemia at 10g/l. Intraoperatively, we found a giant ileocecal fecal impaction extending from the rectosigmoid hinge to the last ileal loops (50 cm from the ileocecal angle) on dolichomegacolon. (Figure 2) We carried out a sigmoidectomy to extract the fecal impaction which weighed 15 KG (figure 3), using the colostomy according to Hartmann. The operating part addressed to the anapath did not show any particularity. Three (3) months later we restored continuity. The ileal fecal masses were extracted manually. The postoperative course was simple; 16 weeks after the first intervention we restored continuity. Conclusion: Fecal impaction occurs when a large amount of fecal matter is compacted and cannot be evacuated spontaneously. It is significantly common in severe chronic constipation and in other at-risk patients with anatomical or functional anorectal abnormalities. Key words: giant fecal impaction, intestinal obstruction, Donka Hospital.