Fecal Impaction

A 76 years female come to ER with complaints of abdominal pain, nausea and intermittent diarrhea since two days. Apparently, she usually has constipation for which she takes laxative. She doesn't have any significant medical problems like Diabetes, HTN or Hypothyroidism. CT scan reveal characteristic finding. Diagnosis and management.



This seems to be a case of fecal impaction wih overflow diarrhea,common in elderly with neurologic/dietary pathology,also long standing constipation and chronic use of laxatives can add to such condition diarrhea is due to overflow of loose stool around fecal impaction in rectum,as per mr upper abdomen to showing fecal matter in transverse colon enema and/or removal of impacted fecal matter manually may have to consider. after removal cause of constipation to acertain and treated diet should include fibers,prokinetic agent should be started

Very well described by Dr. Gupta.

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i dont think surgical intervention is required,abdominal discomfort,nausea anorexia,leakage of liquid stool,and fecal impaction on digital examination is clue to fecal impaction.once the fecal impaction is cleared everything will be normal only problem is treatment of the cause of constipation it should be properly addressed by dietary modifications,inclusion of dietary fiber,and proper use of laxatives

here in this case colorectal ca or neoplasm is excluded i think mri has been ordered to r/o the tumor or malignancy,the other possibility is small gut involvment or paralytic ileus but mri and passage to the liq stool and flatus,no obvius distention of abdomen and mri itself ruled out the possibility

Sir is microbar enema helpful in dis case

if microbar is barium powder for enema then cant use as further impaction due to barium is possible,and if docusate sodium then it is drug of choice,as it softens the stool

Sir it might be an Obstruction at splenic flexure? May b due to ischemia at water shed area that is ARCH OF RYLON....is dere diarrhoea associated with bleeding pr??

Dilated and impacted transverse colon with collapsed descending colon....can try with microbar enema as conservative management ...or else laprotomy...if patient condition is well anaestomosis can b done or else coloctomy or iliostomy...!! Sir plz reply

There is no hematochezia or malena. Surely, we all will find the correct answer at the end of the discussion.

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It's a case of intestinal obstruction secondary to fecal impaction, which result in post-obstructive diarrhea. Often the patient is wrongly diagnosed as having acute gastroenteritis. History will reveal chronic constipation and digital rectal examination will show fecal impaction. Treatment will be to give combination of adequate hydration, enema and polyethylene glycol. Sometimes, careful manual de-impaction will be required, but there will be high risk for rectal mucosal tear. Seldomly, surgery is needed in very complicated cases.

Faecoliths in small gut with distended multiple small gut loops

it's obstruction due to inflammatory bowel condition..barium enema can help in further diagnosis as well as to relieve obstruction

Intestinal obstruction, Advised surgical intervention if not relieved by enema.

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