Giant Fecaloma Research Articles

Massive sigmoid megacolon due to giant fecaloma: A case report of anal stricture

BackgroundA fecaloma is a mass of hardened feces in the colon or rectum, more solid than typical impacted feces, leading to severe intestinal distension. It predominantly affects elderly, frail individuals, children with anorectal deformities, and patients with conditions such as Chagas disease, Hirschsprung's disease, and spinal injuries. Case ReportWe report the case of a 34-year-old man with a history of anal imperforation and subsequent anal stricture, who presented with a massive megacolon due to a giant fecaloma. The patient experienced progressive abdominal distension, colicky pain, and an inability to pass stool for 15 days. Physical examination revealed a tender, distended abdomen and impacted feces in the rectum. Laboratory tests and imaging studies confirmed the diagnosis. An emergency laparotomy revealed a 30 × 30 cm dilated sigmoid colon filled with 15–25 kg of fecal material. The fecaloma was removed via enterectomy, and a Hartmann's procedure with colostomy was performed. Histopathological examination showed no evidence of malignancy. Post-operatively, the patient recovered well and was discharged in good condition. ConclusionThis case highlights the presentation and surgical management of a giant fecaloma causing megacolon. Prompt surgical intervention is critical in managing severe fecaloma to prevent life-threatening complications.

Adverse event of the procedure for prolapsed hemorrhoids: a rare case of anastomotic diverticulum with a giant fecaloma

Adverse event of the procedure for prolapsed hemorrhoids: a rare case of anastomotic diverticulum with a giant fecaloma

A Case of Megacolon with a Giant Fecaloma on Medico-Legal Autopsy

Chronic constipation is one of the causes of megacolon. It is generally a natural death, provided not died during procedure under anesthesia. This case )NM) is of a 15-year girl )NM) who died on the operation table and referred for a medico-legal autopsy. There has been a history of repeated episodes of constipation since the age of six, and frequently hospitalized but no definite diagnosis was made by primary health care physician. On autopsy, large bowel was distended with a hard giant fecaloma. On histopathological examination, hirschsprung’s disease is ruled, and idiopathic megacolon was considered as a cause of death. History, clinical examination, autopsy findings, and histopathological picture along with medical negligence are discussed in this report.

Giant Fecaloma Causing Intestinal Obstruction and Urinary Retention: Rare Case Report

Fecaloma is a mass of hardened feces impacted mostly in left colon and rectum. Several causes of fecalomas have been described in literature, of which chronic constipation. It is a common pathology in elderly patients. The non-specific clinical signs, harmless, sometimes misleading, are at the origin of long evolutions which can lead to real life-threatening situations [1]. We herein report the case of a 61-year-old patient who presents a giant fecaloma located in the sigmoid colon and rectum, associated to urinary retention.

Neuroleptiques Causing a Giant Abdominal Mass

A 39 years old patient was admitted to our hospital, never operated before, with a history of mental illness. The patient was treated for schyzophrenia since the age of 15, under a long term treatment of neurolyptics and antidepressants, with complaints of chronic constipation. The patient reported abdominal pains and cessation of stool and gas, no defectation in 15 days, along with continuous vomitting.The patient was concious, instable TA : 80/40mmHG FC: 120B/m FR : 22 c/m. On initial evaluation we could detect an important abdominal distention as well as an apparent venous collateral circulation accompagnied with tenderness to palpation [Figure A]. Rectal examination revealed the presence of a very hard fecaloma. The initial biological assessment showed functional renal insufficiency, Hyperleukocytosis at 11000 /mm3, hyponatremia at 125 mmol/L. Abdominal tomography revealed a giant fecaloma at the rectum, the sigmoid and the left side of the transverse colon, and a mega colon with a diametre reaching 22 cm wide, the lining of the colon was improperly enhanced after the injection of the contrast agent [Figure B]. The patient was then admitted to the trauma room, he was prepared with a rehydration and hydro-electrolytic compensation. Repeated enemas and laxatives were used to stimulate defectation, but they were all unsuccessful, the hard mass of stool could not be removed. It was decided that the patient required abdominal surgery. Under general anesthesia, patient in supine position, a midline laparotomy was performed. During the exploration, we discovered a colon filled with a giant ficaloma, along with ischemic parietal lesions on the sigmoid [Figure C].
 Resection of the descending and sigmoid colons, manual extraction of the remainder of the fecalomas from the rectum, and terminal colostomy were performed following Hartmann's technique. The patient remained instable even after being treated in intensive care, the patient unfortunately passed away 48 h post operation.
 Constipation is a common problem that can cause fecal impaction and even development of a fecaloma, a mass of inspissated stool. Fecalomas occur more frequently in the left colon and rectum as stool hardens and the colon narrows. Fecalomas can manifest in various ways including bowel obstruction, urinary retention, and toxic megacolon.
 Medica­tions that were significantly associated with constipation were opioids, diuretics, antidepressants, antihistamines, antispasmod­ics, anticonvulsants, and aluminum antacids. The use of acetaminophen (>7 tablets weekly), aspirin, and other NSAIDs was also found to be associated with an increased risk of constipation. Fecalomas can often be treated conservatively with laxatives, enemas, and/or digital disimpaction. However, when these methods are unsuccessful, surgical intervention is required to prevent bowel perforation.
 In patients with history of constipation, new or worsening of abdominal pain, and are under antidepressants and neurolyptic treatment, fecalomas should be considered in the differential diagnosis, and constipation should be aggressively investigated to avoid complications.

Giant Fecaloma Causing Large Bowel Obstruction: A Case Report

Fecalomas are masses of hardened stool that are typically impacted in the sigmoid colon and rectum. Fecalomas are commonly associated with chronic constipation, Hirschsprung’s disease, Chagas disease, and multiple psychiatric conditions. We present a case of a giant fecaloma resulting in complete large bowel obstruction and suggest a five-year abdominal ultrasound monitoring of adults presenting with chronic constipation and/or chronic nonspecific gastrointestinal (GI) complaints.

Giant fecaloma in a 11-year-old-boy

Giant fecaloma in a 11-year-old-boy

Giant fecaloma complicated by hydronephrosis and obstructive pyelonephritis (case report)

Fecal impaction is a common and potentially dangerous disease that occurs in all age groups with a frequency of approximately 15%. Children, the elderly and people with disabilities are considered the most vulnerable. It is a complex diagnostic and therapeutic problem. Coprostasis usually occurs in conditions of chronic or severe constipation, anatomical anorectal abnormalities, and neurogenic or functional gastrointestinal disorders. Fecalomas are one of the manifestations of coprostasis and can lead to a large range of complications. Only knowledge of possible complications and their timely diagnosis can prevent the development of life-threatening conditions. In our work, we present the case of giant fecaloma, complicated by hydronephrosis and obstructive pyelonephritis.

A case report of giant fecaloma in a 35 year old woman

A case report of giant fecaloma in a 35 year old woman

A Case of a Giant Fecaloma

A Case of a Giant Fecaloma

İntestinal obstrüksiyonun nadir bir nedeni jejunal fekalom: Olgu sunumu

Fecalomas are usually found in the colon or the rectum. In adult ages, jejunal giant fecaloma is a very rare condition. It has been thought that there should be any kind of chronic diseases leading to the occurrence of such fecalomas at the unexpected localizations. In this case, it was aimed to present a 50-year-old male patient with small bowel obstruction caused by jejunal giant fecalomas. There was previous gastrojejunostomy with vagotomy as the peptic ulcer surgery 25 years ago. Jejunal resection was performed due to the presence of small necrotic areas on the affected segment caused by impacted jejunal fecaloma. Fecalomas may be considered as a differential diagnosis of small intestinal obstruction in a patient with previous peptic ulcer surgery.

Staged Surgery for Giant Fecaloma Complicating Idiopathic Megacolon

Fecalomas that need surgical management are uncommon. We report a rare case of giant fecaloma in a 22 years old female, with a history of constipation since childhood and an abdominal mass. Abdomen CT scan revealed a giant fecaloma filling sigmoid lumen without signs of ischemia or either complications. Laparotomy and fecaloma extraction trough colotomy was undertaken after failure of conservative measures and endoscopic removal attempt. Hirschsprung disease having been ruled out, sigmoidectomy was performed for idiopathic megacolon. Post operative course was uneventful with good functional outcomes.

Giant Fecaloma Leading to Bilateral Ureterohydronephrosis

Giant Fecaloma Leading to Bilateral Ureterohydronephrosis

A Giant Fecaloma Presenting as Abdominal Mass - A Case Report

Fecaloma of the distal portion of the colon occurs rarely, but it should be considered in differential diagonosis of patients of mass abdomen with history of chronic constipation. The aim of this report is to give brief review of this entity and discuss the different treatment options available for the same.

Idiopathic Sigmoid Megacolon with Fecal Impaction and Giant Calcified Fecaloma

Idiopathic Sigmoid Megacolon with Fecal Impaction and Giant Calcified Fecaloma

A giant fecaloma in a seven-year-old healthy boy

Fecal impaction sometimes grows into a hard and laminated large mass known as a fecaloma which may present features of acute gastrointestinal tract pain or mimic a carcinoma. Patients with fecaloma tend to have underlying conditions such as being elderly, having experienced previous abdominal surgery or having abused drugs (e.g., anticholinergics or narcotics). Although there have been a few reports concerning fecaloma in children complicated with encopresis, cerebral palsy, or Hirschsprung disease, reports of children with giant fecaloma with no underlying diseases are rare.

Acute Urinary Retention in a 47-month-old Girl Caused by the Giant Fecaloma

We present a case of a 47-month-old female suffering from acute urinary bladder neck obstruction and bilateral hydronephrosis secondary to a fecaloma. Fecaloma is defined as an accumulation of inspissated feces in the colon or rectum giving the appearance of an abdominal mass. A fecaloma can be developed by diverse causes and the causes of the fecaloma in this case were septum reformation after the Duhamel procedure and long-term constipation. Chronic constipation is very common at outpatient clinic. However, acute urinary retention and voiding difficulty caused by fecaloma in the giant Duhamel pouch has never been reported in Korea. We would like to present our case with acute urinary retention due to a fecaloma and suggest that fecaloma might be considered as one of the causes for acute urinary retention, especially in cases with previous Duhamel operation for repair of Hischsprung disease.

A “Beehive” in the Abdomen

A 22 years-old woman presenting with intestinal occlusion by a giant fecaloma. Fecal impaction is often misdiagnosed, especially in non collaborating patients. This demonstrates the necessity of particular attention to avoid unnecessary surgical intervention.

A Giant Abdominal Mass: Fecaloma

A 67-year-old man was admitted to our hospital for 2-month constipation, nausea, and abdominal pain. Abdominal distention had been added to his list of complaints for about 2 weeks. He was not able to pass stool but did have discharge of gas. The patient had no history of serious illness, hospitalization, or major surgery, but he had been smoking cigarettes and cannabis and using various kinds of laxatives for many years. On initial evaluation, he had a temperature of 37.8°C, a heart rate of 106 beats per minute, respiratory rate of 16 breaths per minute, and blood pressure of 95/60 mm Hg. He was found to be in an agitated condition; on physical examination, his skin was wet and the patient seemed anxious. Bowel sounds were hypoactive, especially in the left quadrant. Palpation revealed a hard, nonmobile, tender abdominal mass filling the mid and left abdominal quadrants (Figure A). Digital rectal examination revealed hard stool impaction. Blood tests revealed: hemoglobin, 15 g/dL; hematocrit, 42; white blood cells, 16.800/mL; sedimentation rate, 61 mm per hour; blood glucose, 148 mg/dL; urea, 58; creatinine, 0.6; Na, 135; protein, 5.5; and albumin, 3.1 g/dL. Carcino-embryonic antigen, CA 19–9, and alpha-fetoprotein levels were normal. Abdominal tomography showed a giant fecaloma in the pelvis and left side of the abdomen causing displacement of visceral structures to the right side (Figure B; b, bladder; f, fecaloma). A hard mass of feces that could not be fragmented was noted on sigmoidoscopic examination. Repeated enemas and laxatives were used to stimulate defecation, but they were all unsuccessful. It was decided that the patient required abdominal surgery. Laparotomy was performed with a midline incision. During the exploration, we discovered that the descending and sigmoid colons were filled with a giant fecaloma. To extract the colon from the abdomen, a midline incision was made, extending from the xiphoid process to the level of the pubic symphysis. The diameter of the sigmoid colon was approximately 20 cm (Figure C). Resection of the descending and sigmoid colons, manual extraction of the remainder of the fecalomas from the rectum, and terminal colostomy were performed following Hartmann's technique (Figure D). The histopathologic study revealed atrophy of the mucosa and submucosa (Figure E), and pigmented macrophages in the lamina propria (melanosis coli) (Figure F). These histopathologic results were compatible with idiopathic megarectum and megacolon. Fecal impaction is a common and disturbing problem. Fecalomas occur most frequently in the distal colon and rectum and commonly give rise to obstruction. It can cause some serious complications such as colonic obstruction and perforation, sciatica, ureter obstruction secondary hydronephrosis, and deep vein thrombosis.1Nguyen H. Simpson R.R. Kennedy M.L. et al.Idiopathic megacolon causing iliac vein occlusion and hydronephrosis.Aust N Z J Surg. 2000; 70: 539-542Crossref PubMed Scopus (9) Google Scholar, 2Alvarez C. Hernández M.A. Quintano A. Clinical challenges and images in GI: Image 2: Deep venous thrombosis due to idiopathic megarectum and giant fecaloma.Gastroenterology. 2006; 131 (983): 702-703Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Without an organic cause, and if accompanied by a progressive expansion, this condition is called idiopathic megacolon.3Gladman M.A. Dvorkin L.S. Scott S.M. et al.A novel technique to identify patients with megarectum.Dis Colon Rectum. 2007; 50: 621-629Crossref PubMed Scopus (19) Google Scholar Rectosigmoidoscopy, barium enema, and abdominal tomography scan play important roles in differential diagnosis. Commonly, fecalomas can be treated by conservative methods such as laxatives, enemas, and digital evacuation. However, sometimes, as in this case, surgical intervention may be required for removal of the fecaloma.4Gladman M.A. Scott S.M. Lunniss P.J. et al.Systematic review of surgical options for idiopathic megarectum and megacolon.Ann Surg. 2005; 241: 562-574Crossref PubMed Scopus (85) Google Scholar, 5Rajagopal A. Martin J. Giant fecaloma with idiopathic sigmoid megacolon: report of a case and review of the literature.Dis Colon Rectum. 2002; 45: 833-835Crossref PubMed Scopus (29) Google Scholar Melanosis coli is characterized by pigmented macrophages in the mucosa and is a common side effect of prolonged laxative use.6Villanacci V. Bassotti G. Cathomas G. et al.Is pseudomelanosis coli a marker of colonic neuropathy in severely constipated patients?.Histopathology. 2006; 49: 132-137Crossref PubMed Scopus (20) Google Scholar

Giant Fecaloma in an Adult with Severe Anal Stricture Caused by Anal Imperforation Treated by Proctocolectomy and Ileostomy

Although fecalomas are relatively common in patients who are elderly, constipated, or who have spinal injuries, a giant fecaloma formation unresponsive to conservative treatment is a rare condition that sometimes requires surgery for complications. Herein we report a case of a long-lasting (46 years) giant fecaloma associated with severe anal stricture after surgery for anal atresia and resulting in severe malnutrition, bone structural changes, and severe impairment of quality of life. Eight months after treatment by total proctocolectomy and ileostomy, the patient was on a free diet and had gained more than 10 percent of his postoperative body weight; improvements were observed in the tone of the abdominal muscles and in his quality of life.