1/114. Retained fecalith after laparoscopic appendectomy. An intraabdominal abscess developed from a retained fecalith following laparoscopic appendectomy. We discuss the prevention and management of retained fecaliths in light of the numerous reports of retained gallstones. ( info) |
2/114. Duplication of the vermiform appendix. In this brief report, the authors present a case of duplication of the vermiform appendix with appendicitis occurring in both appendices and causing small bowel obstruction. ( info) |
3/114. Bilateral hydronephrosis due to fecaloma in an elderly woman. By computer search of the literature, we found few cases of hydronephrosis due to fecal impaction. Because such a complication is extremely rare, we describe an 81-year-old woman with dementia, gallstones, arterial hypertension, and diverticulosis of the sigma who was hospitalized for severe constipation, fecaloma, and bilateral hydronephrosis. Through simultaneous lavage by two rectal tubes and manual disimpaction of fecaloma, bilateral hydronephrosis was resolved. We also briefly review the appropriate literature. ( info) |
| We present a case report of the first adult woman reported to suffer from both urethral obstruction and bilateral ureteral hydronephroses secondary to fecal impaction. The work-up suggested that hypothyroidism might be the cause for fecal impaction. urinary tract obstruction caused by hypothyroidism-induced fecal impaction has never been reported. fecal impaction should be considered as one of the causes for urinary tract obstruction. ( info) |
5/114. fecal impaction causing megarectum-producing colorectal catastrophes. A report of two cases. PURPOSE: Massive fecal impaction leading to surgical catastrophes has rarely been reported. We present 2 such patients to remind physicians that neglected accumulation of fecal matter in the rectum may lead to ischemia and perforation of the colon and rectum. methods: Report of 2 patients and a medline search of the literature. RESULTS: In the 1st case massive fecal impaction produced an abdominal compartment syndrome and rectal necrosis. In the 2nd patient fecal impaction resulted in colonic obstruction and ischemia. In both, an operation was life-saving. CONCLUSION: Neglected fecal impaction may lead to a megarectum causing an abdominal compartment syndrome and colorectal obstruction, perforation or necrosis. Measures to prevent fecal impaction are of paramount importance and prompt manual disimpaction before the above complications develop is mandatory. Appropriate operative treatment may be life-saving. ( info) |
6/114. Diagnostic and therapeutic considerations for fecal impaction. During an 18-month period, 18 patients were admitted to the Beth israel Hospital because of fecal impaction or its complications. The records of the 18 patients were reviewed to determine the presenting signs and symptoms, radiologic findings, course and etiology of fecal impaction. Prior use of drugs that slow gastrointestinal motility was found in seven cases, and seven of the 18 patients had severe neuropsychiatric illness. The presenting signs and symptoms in almost all instances were consistent with a diagnosis of intestinal obstruction. The difficulty in differentiating intestinal obstruction caused by fecal impaction from obstruction resulting from other lesions is discussed. The diagnosis of fecal impaction should be entertained only after other causes of intestinal obstruction have been excluded. ( info) |
7/114. barium impaction as a complication of gastrointestinal scleroderma. Two patients with scleroderma of the bowel experienced life-threatening barium impaction after upper intestinal x-ray studies. Although the frequency of this complication is unknown, the difficulty of managing it when it occurs makes prevention imperative. X-ray studies should be performed only after careful consideration of the risks and benefits. When x-ray studies are performed, the patient should be vigorously purged soon thereafter, and a follow-up roentgenogram should be obtained to confirm adequate removal of barium. ( info) |
8/114. Abdominal compartment syndrome in a patient with congenital megacolon. A 13-year-old male with a history of chronic congenital megacolon presented to the emergency department with a 1-day history of increasing abdominal pain, distension, and emesis. The patient was admitted for bowel disimpaction and irrigation. The patient rapidly developed an acute abdominal compartment syndrome because of his massive colonic dilation. Surgical decompression resulted in a reperfusion phenomenon and ultimately resulted in coagulopathy and patient demise. This case presents a unique cause of the abdominal compartment syndrome and discusses the implications to the emergency physician. ( info) |
9/114. Rectal carcinoma with stercoral ulcer perforation. We report a case of ruptured stercoral ulceration due to chronic constipation which is caused by rectal carcinoma. This case suffered from difficulty of stool passage for 5 months. Periumbilical pain and current-jelly stool were experienced before his admission. physical examination revealed diffuse abdominal rebounding pain and laboratory data showed leukocytosis. Computed tomography demonstrated marked dilatation of the sigmoid colon with stool impaction due to neoplastic growth in the rectosigmoid junction. Thickening and edematous change of the colonic wall were noted. There was amorphous material with gas in the mesocolon, which indicated fecal peritonitis. Emergent operation with Hartman's procedure and left colostomy was performed. Diffuse pressure gangrene of the sigmoid colon wall with a perforating hole was identified. Pathologically, the resected colon specimen showed non-specific-acute and chronic inflammatory change. The perforating hole was surrounded by a necrotic border of ulcerative mucosa. After the operation, pelvic drainage was undertaken for 1 month and then the patient was discharged uneventfully. ( info) |
10/114. Idiopathic megarectum complicating pregnancy: report of a case. pregnancy often exacerbates constipation in young women with chronic constipation syndromes. The presence of the fetus presents a challenge in both the diagnosis and treatment of these syndromes. This study was conducted to report a rare case of idiopathic megarectum complicating a pregnancy. An aggressive polyethylene glycol (PEG) regimen allowed the patient to carry the child to term and to have a normal vaginal delivery. Successful proctocolectomy was performed with coloanal anastomosis 3 months postpartum. The patient has been free of constipation for 18 months without the need for cathartics or laxatives. All efforts to avoid operative intervention should be made in constipated patients during pregnancy. This principle holds true even in the setting of dilated large bowel. Idiopathic megarectum and the management of constipation in pregnancy are discussed. ( info) |