Massive Fecal Impaction

Abstract

An 89-year-old woman with chronic constipation presented with abdominal pain and distention of 3 days’ duration. Her medical history was significant for hypertension (on amlodipine), obesity, dyslipidemia, iron (on supplemental iron), and vitamin B12 deficiency. A colonoscopy performed more than 10 years ago was normal. The examination showed a severely distended, tympanic abdomen with mild generalized tenderness. Computed tomography of the abdomen showed massive fecal impaction measuring 40 × 26 × 23 cm (Figure A, sagittal view; Figure B, coronal view) extending into the distal sigmoid colon with bilateral hydroureteronephrosis owing to the mass effect (Figure C).