Fecal impaction: Difference between revisions
No edit summary |
|||
| Line 3: | Line 3: | ||
===Risk Factors=== | ===Risk Factors=== | ||
* | *Elderly and young age | ||
* | *Chronic constipation | ||
* | *Lifestyle factors (immobility, low fiber diets, 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== | ==Clinical Features== | ||
History: | History: | ||
* | *Abdominal pain or bloating | ||
* | *Nausea and vomiting | ||
* | *Obstipation | ||
* | *Agitation/confusion (elderly patients with neuropsychiatric conditions) | ||
* | *Urinary incontinence | ||
* | *Overflow stool incontinence | ||
Physical exam: | Physical exam: | ||
* | *Abdominal distention and/or tenderness | ||
* | *Palpable firm stool balls on digital rectal exam | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 31: | Line 31: | ||
==Evaluation== | ==Evaluation== | ||
* | *Digital rectal exam | ||
* | *Chemistry to evaluate for hypokalemia or hypercalcemia | ||
*TSH if indicated | *TSH if indicated | ||
*Abdominal X-Ray to evaluate for air-fluid levels and free-air | *Abdominal X-Ray to evaluate for air-fluid levels and free-air | ||
| Line 40: | Line 40: | ||
==Management== | ==Management== | ||
* | *Surgery if there are signs of perforation or peritonitis | ||
* | *Distal impactions - 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 | ||
==Disposition== | ==Disposition== | ||
| Line 50: | Line 50: | ||
==See Also== | ==See Also== | ||
*[[Constipation]] | *[[Constipation]] | ||
Revision as of 23:28, 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 diets, 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 - 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.