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.
- SourceAvailable from: PubMed Central[Show abstract] [Hide abstract]
ABSTRACT: Fecal impaction is a disorder characterized by a large mass of compacted feces in the rectum and/or colon, which cannot be evacuated. For mild and moderate fecal impaction, recommended treatments include stool softeners, oral mineral and olive oil, and edema; for severe fecal impaction, manual removal is needed and sometimes laparotomy may be indicated if medical therapies are not effective. Here we report a case with severe fecal impaction who did not defecate for 75 days. We treated this patient with vegetable oil, Chinese traditional medicine and enema in sequence. After 12 days of therapy, she evacuated hard fecal masses, and the symptoms were relieved.Journal of neurogastroenterology and motility 04/2010; 16(2):199-202. · 2.70 Impact Factor
- [Show abstract] [Hide abstract]
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
- Journal of the American Geriatrics Society 01/2010; 58(1):213-4. · 4.22 Impact Factor