Megacolon and stercoral proctitis after frequent fecal impactions: report of an unusual case and review of the literature.
ABSTRACT Persistent megacolon that results from frequent episodes of fecal impaction without adequate treatment is a rare and seldom reported condition in the elderly. This report discusses a 72-year-old white woman presenting with a large abdominal mass, who had at least 4 episodes of radiographically demonstrated fecal impaction over the previous year without adequate treatment. The patient required hospitalization for a bleeding rectal ulcer during the second episode of fecal impaction. Computed tomography (CT) scans on this admission revealed a dilated colon up to 16 x 14 cm in maximal dimensions extending over 30 cm, filled with massive fecal material. Several follow-up abdominal radiographs revealed a persistent megacolon after 10 months despite the absence of significant fecal material in the rectosigmoid colon. While multiple contributing factors were likely involved in her frequent fecal impactions, the clinical course of this case suggests that frequent fecal impactions without adequate treatment can lead to megacolon in high-risk patients. Clinicians should aggressively treat fecal impaction and monitor the adequacy of treatment with abdominal radiography in order to avoid significant complications. Complications and management of fecal impaction and the pathophysiology of megacolon in the literature are reviewed and discussed.
Conference Paper: Merits of hybrid optical networking[Show abstract] [Hide abstract]
ABSTRACT: The usable capacity in the fiber is limited by the operating windows in the different bands. Within these constraints, the cost of the WDM line at high capacities is directly dependent on the spectral efficiency, which can be defined as the ratio of the bit rate per channel to the inter-channel spacing. The higher the spectral efficiency is, the higher is the capacity that can be packed into a single fiber.Optical Fiber Communication Conference and Exhibit, 2002. OFC 2002; 04/2002
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ABSTRACT: To assess the reliability of applying a radiographic scoring system in estimating the severity of stool retention (SR) in hospitalized older adults with constipation, and to identify risk factors associated with clinical constipation and SR scores. Retrospective, case series study. Southeast Ohio community hospital. Adults 65 years or older with constipation or fecal impaction and abdominal radiographs available (N=122). Bowel obstruction was excluded. Radiographs were independently scored by four readers twice, "5" being the most severe, for each quadrant of an abdominal film; possible total score was 0 to 20. Clinical constipation was defined as an average SR score of 13 or higher. Intra-class correlation was used to measure inter-rater agreement. The overall inter-rater agreement on abdominal radiograph readings was 0.91, 95% confidence interval (CI)=0.88-0.93. Clinical constipation was associated with the use of statins and antimuscarinics by univariate logistic regression analysis. After adjusting for age, sex, residency, smoking history, oral laxatives, and self-reported constipation, the use of statins remained significantly associated with clinical constipation (OR=3.86, 95% CI=1.08-13.77, P=.036). Univariate linear regression analysis revealed that higher SR scores were associated with community residency, self-reported constipation, and the use of statins and antimuscarinics. After adjusting for the above confounders by multiple linear regression analyses, the use of antimuscarinics was independently associated with higher SR score (β=1.769, 95% CI=0.008-3.531, P=.049). Abdominal radiography was reliable in assessing the severity of SR in older adults with constipation. The use of statins and antimuscarinics was associated with clinical constipation and greater SR.Journal of the American Medical Directors Association 10/2010; 11(8):572-8. · 5.30 Impact Factor
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ABSTRACT: We report a case of sudden death due to a catastrophic spontaneous rupture of a urinary bladder associated with megacolon due to a fecal impaction (fecaloma). The massively distended rectum and sigmoid colon filled the pelvic cavity and pressed up against the posterior aspects of the uterus, vagina, and urinary bladder. This produced bladder outlet obstruction, followed by massive dilatation and rupture of the urinary bladder, bilateral hydronephrosis, and a 3.5 liter collection of urinary fluid within the abdominal cavity. Complications of chronic constipation, fecalomas, and rupture of the urinary bladder are reviewed.The American journal of forensic medicine and pathology: official publication of the National Association of Medical Examiners 10/2009; 30(3):280-3. · 0.71 Impact Factor