Fecaloma mimicking acute abdomen: a diagnostic challenge
Keywords:Acute abdomen, Fecaloma, Treatment approach
Fecaloma can occur as a result of several causes and may present as a challenging diagnostic and therapeutic problem. In this case report, we would like to present the case of a 37-year-old male who presented with abdominal distention and pain. His previous medical history was significant for catatonic disorder due to psychiatric conditions. Physical examination showed a distended abdomen with focal tenderness in the lower quadrant regions. Bowel sounds were decreased and fecal materials were palpable on digital rectal examination. Upon further clinical interrogation, the patient admitted to constipation for the past three months. Except for leukocytosis (28,000/mm3 (normal range 4.5-10.5/mm3) and elevated C reactive protein (304mg/L) levels, all other laboratory findings were normal. Abdominal plain x-ray demonstrated a predominantly feces-filled colon. This was confirmed on abdominal computed tomography (CT) scan as a giant sigmoid colon, measuring 25 cm in diameter and lateralized bladder. The patient was initially treated with oral laxatives and rectal enema, which were ineffective. He was then treated with evacuation of the feces under general anesthesia. After then, patient’s symptoms were relieved. Post-operative CT imaging confirmed a decrease in the size of the sigmoid colon to an acceptable measure. No mass or polypoid lesions were seen on colonoscopy. This report attracts the attention how sigmoid colon can be a long-term reservoir for fecal contents without serious symptoms but only abdominal distention. Evacuation of fecal contents under general anesthesia may help to relieve fecaloma without surgery.