Fecal impaction: Difference between revisions
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===Risk Factors=== | ===Risk Factors=== | ||
*Elderly and young age | *Elderly and young age | ||
*Chronic constipation | *Chronic [[constipation]] | ||
*Lifestyle factors (immobility, low fiber | *Lifestyle factors (immobility, low fiber diet, dehydration) | ||
*Medications that impair GI motility (anticholinergics, antipsychotics, opioids) | *Medications that impair GI motility ([[anticholinergics]], [[antipsychotics]], [[opioids]]) | ||
*Anatomic abnormalities (malignancy, anorectal disease, Hirschsprung) | *Anatomic abnormalities (malignancy, anorectal disease, [[Hirschsprung]]) | ||
*Neurologic conditions (dementia, spinal cord injury, cerebral palsy) | *Neurologic conditions ([[dementia]], spinal cord injury, [[cerebral palsy]]) | ||
==Clinical Features== | ==Clinical Features== | ||
History: | History: | ||
*Abdominal pain or bloating | *[[Abdominal pain]] or bloating | ||
*Nausea and vomiting | *Nausea and vomiting | ||
*Obstipation | *Obstipation | ||
*Agitation/confusion (elderly patients with neuropsychiatric conditions) | *Agitation/confusion (elderly patients with neuropsychiatric conditions) | ||
*Urinary incontinence | *[[Urinary incontinence]] | ||
*Overflow stool incontinence | *Overflow stool incontinence | ||
| Line 26: | Line 26: | ||
*[[Constipation]] | *[[Constipation]] | ||
*Colorectal malignancy | *Colorectal malignancy | ||
*Diverticulitis | *[[Diverticulitis]] | ||
*Bowel obstruction | *[[Bowel obstruction]] | ||
*Stercoral colitis | *[[Stercoral colitis]] | ||
==Evaluation== | ==Evaluation== | ||
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*Abdominal X-Ray to evaluate for air-fluid levels and free-air | *Abdominal X-Ray to evaluate for air-fluid levels and free-air | ||
*CT if severe presentation | *CT if severe presentation | ||
**Stercoral colitis is CT finding caused by impacted fecal material causing pressure edema and ischemia on the bowel wall. Left untreated, the condition can lead to wall ischemia, ulceration, and perforation.<ref> Ünal E, Onur MR, Balcı S, Görmez A, Akpınar E, Böge M. Stercoral colitis: diagnostic value of CT findings. Diagn Interv Radiol. 2017;23(1):5-9.</ref> | **[[Stercoral colitis]] is CT finding caused by impacted fecal material causing pressure edema and ischemia on the bowel wall. Left untreated, the condition can lead to wall ischemia, ulceration, and perforation.<ref> Ünal E, Onur MR, Balcı S, Görmez A, Akpınar E, Böge M. Stercoral colitis: diagnostic value of CT findings. Diagn Interv Radiol. 2017;23(1):5-9.</ref> | ||
***Findings include colonic wall thickening, pericolonic fat stranding, and extraluminal bubbles of gas or abscess (signs of perforation); all of which are not found in uncomplicated fecal impaction. | ***Findings include colonic wall thickening, pericolonic fat stranding, and extraluminal bubbles of gas or abscess (signs of perforation); all of which are not found in uncomplicated fecal impaction. | ||
==Management== | ==Management== | ||
*Surgery if there are signs of perforation or peritonitis | *Surgery if there are signs of perforation or peritonitis | ||
*Distal impactions - disimpaction and/or rectal suppositories or enemas | *Distal impactions - manual disimpaction and/or rectal suppositories or enemas | ||
*Proximal impactions typically respond better to oral laxatives | *Proximal impactions typically respond better to oral laxatives | ||
*After initial disimpaction, address risk factors and initiate a maintenance bowel regimen | *After initial disimpaction, address risk factors and initiate a maintenance bowel regimen | ||
==Disposition== | ==Disposition== | ||
*Consider admission for patient's with stercoral colitis for aggressive bowel regimen and washout | *Consider admission for patient's with [[stercoral colitis]] for aggressive bowel regimen and washout | ||
==See Also== | ==See Also== | ||
Revision as of 23:31, 4 June 2019
Background
- Typically a complication of chronic constipation that results in the accumulation hardened fecal matter in the colon or rectum that cannot be spontaneously evacuated
Risk Factors
- Elderly and young age
- Chronic constipation
- Lifestyle factors (immobility, low fiber diet, dehydration)
- Medications that impair GI motility (anticholinergics, antipsychotics, opioids)
- Anatomic abnormalities (malignancy, anorectal disease, Hirschsprung)
- Neurologic conditions (dementia, spinal cord injury, cerebral palsy)
Clinical Features
History:
- Abdominal pain or bloating
- Nausea and vomiting
- Obstipation
- Agitation/confusion (elderly patients with neuropsychiatric conditions)
- Urinary incontinence
- Overflow stool incontinence
Physical exam:
- Abdominal distention and/or tenderness
- Palpable firm stool balls on digital rectal exam
Differential Diagnosis
- Constipation
- Colorectal malignancy
- Diverticulitis
- Bowel obstruction
- Stercoral colitis
Evaluation
- Digital rectal exam
- Chemistry to evaluate for hypokalemia or hypercalcemia
- TSH if indicated
- Abdominal X-Ray to evaluate for air-fluid levels and free-air
- CT if severe presentation
- Stercoral colitis is CT finding caused by impacted fecal material causing pressure edema and ischemia on the bowel wall. Left untreated, the condition can lead to wall ischemia, ulceration, and perforation.[1]
- Findings include colonic wall thickening, pericolonic fat stranding, and extraluminal bubbles of gas or abscess (signs of perforation); all of which are not found in uncomplicated fecal impaction.
- Stercoral colitis is CT finding caused by impacted fecal material causing pressure edema and ischemia on the bowel wall. Left untreated, the condition can lead to wall ischemia, ulceration, and perforation.[1]
Management
- Surgery if there are signs of perforation or peritonitis
- Distal impactions - manual disimpaction and/or rectal suppositories or enemas
- Proximal impactions typically respond better to oral laxatives
- After initial disimpaction, address risk factors and initiate a maintenance bowel regimen
Disposition
- Consider admission for patient's with stercoral colitis for aggressive bowel regimen and washout
See Also
References
- ↑ Ünal E, Onur MR, Balcı S, Görmez A, Akpınar E, Böge M. Stercoral colitis: diagnostic value of CT findings. Diagn Interv Radiol. 2017;23(1):5-9.