A Case of Giant Fecaloma in a 32-Year-Old Woman

Case Report

Austin J Clin Case Rep. 2014;1(4): 1017.

A Case of Giant Fecaloma in a 32-Year-Old Woman

Monica Gupta1*, Purnima Aggarwal2, Ram Singh1 and Lehl SS1

1Department of Medicine, Government Medical College and Hospital, India

2Department of Radiology, Government Medical College and Hospital, India

*Corresponding author: Monica Gupta, Department of Medicine, Government Medical College and Hospital, 1156-C, 32-B, Chandigarh, India

Received: June 02, 2014; Accepted: June 16, 2014; Published: June 18, 2014


Chronic constipation is a very common complaint at outpatient clinics. It can progress to fecal impaction if not managed promptly. However rarely it may be extreme causing abdominal distension masquerading an abdominal tumor. We present an unusual case of a 32-year-old mentally challenged female who developed a fecaloma associated with chronic constipation, which was managed conservatively. Diagnosis of fecaloma must be considered in patients presenting with chronic constipation and abdominal mass.

Keywords: Chronic constipation; Fecaloma; Ureters


Fecaloma is defined a mass of inspissated feces accumulated in the colon or rectum that is much harder in consistency than impacted feces. The feces initially accumulate, then stagnate and get impacted due to coprostasis, expand and deform the intestine, and develop into large tumor like masses. Fecalomas, often giant ones have been described in Hirschsprung’s disease, psychiatric patients, neglected elderly or bedridden patients, Chagas disease, inflammatory and neoplastic conditions, and in patients suffering from idiopathic chronic constipation.

Clinical Presentation

A 32-year old mentally challenged female reported to our medical unit with 1 year history of progressive constipation and slowly increasing abdominal distension. Caretakers gave the history of 1 bowel movement every third-fourth day with passage of hard stools for initial 6 months, but lately she had spurious diarrhea following daily laxatives use. No history of nausea, vomiting or blood in stools was forthcoming. There was no history of fever, anorexia, weight loss or previous hospitalizations. No urinary complaints were present. Patient had cerebral palsy since childhood and was unable to carry out activities of daily living independently. However there was no history to suggest anorexia or bulimia nervosa.

Examination revealed a normal temperature, supine blood pressure of 110/70 mm Hg, pulse rate of 75/min, a respiratory rate of 14 breaths/min. She weighed 46 kg with good overall nourishment. Abdominal inspection revealed an irregularly distended abdomen especially so in the left half with no evidence of increased peristalsis. During palpation, multiple hard nodular but mobile lumps were palpable in left lumbar, iliac and hypogastric areas. There was no hepatosplenomegaly. Bowel sound appeared normal. Per Rectal examination was reminiscent of rectum loaded with hard feces. No major physical malformations were notable during the examination. Rest of the systemic examination was unremarkable.

Laboratory investigations revealed a hemoglobin 11.2 g/dl, WBC 7000/ mm3, platelets 2.74 lakh/mm and ESR of 24 mm in the first hour. The renal functions and serum electrolytes were normal at creatinine of 0.8 mg/dl, serum Na 140mEq/L, serum K 4.3mEq/L, urinalysis and liver function tests were normal. Chest radiograph was unremarkable. Ultrasound of the abdomen showed evidence of large calcified mass lesions in the para-umblical region extending into the pelvis. Contract enhanced CT abdomen; delayed images revealed dilated rectum as well as sigmoid colon due to loaded fecoliths and extending into the other parts of large bowel (Figure 1a and 1b). Mass effect was also observed on the urinary bladder and bilateral ureters, but there was no evidence of hydronephrosis. Patient was administered repeated enemas, fecal disimpaction per rectum with digital evacuation and laxatives, following which the constipation was partially relieved. Patient did not cooperate for colonoscopy and caretakers refused any further surgical intervention. Patient is under regular follow up for more than 2 years and there has been no complication so far.

Citation: Gupta M, Aggarwal P, Singh R and Lehl SS. A Case of Giant Fecaloma in a 32-Year-Old Woman. Austin J Clin Case Rep. 2014;1(4): 1017. ISSN 2381-912X