Pediatr Gastroenterol Hepatol Nutr.  2015 Sep;18(3):193-196. 10.5223/pghn.2015.18.3.193.

Ileal Fecaloma Presenting with Small Bowel Obstruction

• Yoo HY
• Park HW
• Chang SH
• Bae SH

• KMID: 2068797
• DOI: http://doi.org/10.5223/pghn.2015.18.3.193

Abstract

A fecaloma refers to a mass of accumulated feces that is much harder than a mass associated with fecal impaction. Fecalomas are usually found in the rectosigmoid area. A 10-year-old male with chronic constipation was admitted because of increasing abdominal pain. An abdominal computed tomography scan and a simple abdominal x-ray revealed rapidly evolving mechanical obstruction in the small intestine. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, surgical intervention may be needed. In this case, an emergency operation was performed and a 4x3x2.5 cm fecaloma was found in the distal ileum. We thus report a case of ileal fecaloma inducing small bowel obstruction in a patient with chronic constipation, who required surgical intervention. When symptoms of acute small intestinal obstruction develop in a patient with chronic constipation, a fecaloma should be considered in differential diagnosis.

Keyword

Feces; Abdominal pain; Intestinal obstruction

MeSH Terms

Abdominal Pain
Child
Constipation
Diagnosis, Differential
Emergencies
Enema
Fecal Impaction
Feces
Humans
Ileum
Intestinal Obstruction
Intestine, Small
Laxatives
Male
Laxatives

Figure

• 

  Fig. 1 A plain x-ray of the abdomen (A: supine view, B: erect view) showing a mechanical small bowel obstruction with 'step-ladder' air-fluid pattern in the erect film.

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  Fig. 2 Abdominopelvic computed tomography scan (A: axial view, B: coronal view) showing the 1.8 cm-sized round intraluminal hypodense mass (black arrows) with a 'mottled gas' pattern in the lumen of distal ileum.

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  Fig. 3 The fecaloma. A 4×3×2.5 cm-sized fecaloma was found in the distal ileum at 65 cm proximal to the ileocecal valve, and removed through enterotomy.

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