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The article presents a case study of a 7-year-old pediatric patient with stercoral colitis and acute kidney injury resulting from chronic constipation. Topics discussed include the recognition of conditions like stercoral colitis in children, the widespread and often underdiagnosed nature of chronic constipation, and the potential long-term complications that can arise if this condition is not adequately managed.

Objective: To investigate the diagnostic and therapeutic value of direct visualization (single-use eyeMax subscope) endoscopic management of acute uncomplicated appendicitis. Methods: Thirty-six patients diagnosed with acute uncomplicated appendicitis, confirmed by computed tomography or ultrasonography, from Jan 2023 to Feb 2024 were enrolled in this study. We collected demographics, colonoscopy findings, subscope findings, clinical outcomes of endoscopic retrograde appendicitis therapy (ERAT), and adverse events associated with ERAT. Results: Appendiceal intubation was successful for all 36 patients. Thirty-five patients (97.2%) were definitely confirmed as having acute uncomplicated appendicitis. One patient with negative appendicitis was diagnosed as having cecal diverticulitis with fecalith incarceration. The mean procedure time was 13.1 ± 13.6 min. One patient presented with worsening abdominal pain, and a computed tomography scan suggested a perforated appendix. The mean length of hospitalizations was 1.78 ± 2 days. The mean follow-up was 158 days; during this period, two patients (5.6%) experienced recurrent abdominal pain after 23 and 88 days and subsequently underwent laparoscopic appendectomy. Conclusion: Direct visualization ERAT may be effective for diagnosing and treating acute uncomplicated appendicitis and seems to have a low complication rate. [ABSTRACT FROM AUTHOR]

Constipation and fecal impaction are common issues with the potential for significant morbidity in older people presenting to the Emergency Department (ED). While many of these patients present with classical symptoms of constipation or fecal impaction, atypical presentations are also frequent. These atypical presentations may include paradoxical diarrhea, fecal incontinence, urinary retention or overflow incontinence, hyperactive or hypoactive delirium, anorexia/dysphagia, and syncope. In addition, various clinical conditions (such as dementia, Parkinson's disease, dehydration, and hypothyroidism) and medications (such as opiate analgesics, anticholinergics, diuretics, calcium channel blockers, anti-parkinsonian drugs, and oral iron supplements) are associated with constipation and should be considered during the diagnostic process in the ED. This narrative review specifically focuses on the prevalence, presentation, diagnoses, and management of constipation in older ED patients. [ABSTRACT FROM AUTHOR]

Purpose: The management of bowel bladder disorder (BBD) has only been indicated for subjective constipation without objective evidence. We attempted to highlight the radiological findings in patients with BBD and construct a scoring system to identify patients with BBD prior to treatment. Materials and Methods: Forty-five patients with lower urinary tract dysfunction (LUTD) received polyethylene glycol for 2 months before bladder medication for LUTD. Based on partial response to LUTD following treatment, we divided the patients into LUTD-fecal impaction (FI) and LUTD not attributed to FI (LUTD-NFI) groups. Pre/post-treatment kidney, ureter, and bladder (KUB) were compared with respect to several radiographic parameters. Items with significant changes after treatment were included in the scoring system. The accuracy and inter-rater agreement were also evaluated. Results: Cecal dilation, descending colon dilation, fecal quality, and overall haziness were found to undergo significant changes after laxative treatment. We assigned 0 to 2 points for each item, with a total score of 8. Receiver operating characteristic curve analysis revealed a cutoff value of 5 between LUTD-FI and LUTD-NFI, with 79% sensitivity and 88% specificity. The scoring system was instructed to six doctors who were unaware of it and was then tested on previous patients, which showed a substantial concordance rate (κ=0.79, p

Background: Transabdominal ultrasound is used to detect fecal impaction, but the rectum is difficult to visualize without bladder urine or with gastrointestinal gas. Objective: We developed a transgluteal cleft approach that is unaffected by these factors and sought to determine if our ultrasound method could detect and classify fecal matter in the lower rectum using this approach. Methods: We classified ultrasound images from hospitalized patients into four groups: Group 1 (bowed and rock-like echogenic areas), Group 2 (irregular and cotton candy-like hyperechoic areas), Group 3 (flat and mousse-like hyperechoic areas), and Group 4 (linear echogenic areas in the lumen). Stool characteristics were classified as hard, normal, and muddy/watery. Sensitivity and specificity were determined based on fecal impaction and stool classification accuracy. Results: We obtained 129 ultrasound images of 23 patients. The sensitivity and specificity for fecal retention in the rectum were both 100.0%. The recall rates were 71.8% for Group 1, 93.1% for Group 2, 100.0% for Group 3, and 100.0% for Group 4. The precision rates were 96.6% for Group 1, 71.1% for Group 2, 88.9% for Group 3, and 100.0% for Group 4. Our method was 89.9% accurate overall. Conclusion: Transgluteal cleft approach ultrasound scanning can detect and classify fecal properties with high accuracy. [ABSTRACT FROM AUTHOR]

The aim of this review is to consolidate the current literature on the diagnosis, trends, and management of faecal impaction in the elderly population. Constipation is a commonly occurring issue in clinical practise. Faecal impaction is a more severe and debilitating complication. Whilst constipation is well researched, there is limited discussion on faecal impaction which is often labelled as a complication of chronic constipation. Faecal impaction is of relevance to the elderly population due to their susceptibility to complications and morbidity. A systematic search of PubMed and EMBASE databases was conducted, and 14 articles were included in the final review. Multiple associated factors were identified including low fibre diet, reduced fluid intake, medications, neurological disorders, and lack of physical activity. This review further explores management options and potential complications of faecal impaction. Finally, this review highlights the importance of preventative measures including close monitoring of patients and early initiation of bowel regimes. This review concludes that further research is needed in this area and an improved methodology for collecting data on faecal impaction in the elderly and institutionalised patients. [ABSTRACT FROM AUTHOR]

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Background: Fecal impaction is a digestive system disease, that is most common in the elderly population and becomes more prevalent with increasing age. Manual removal can successfully remove the impaction in 80% of fecal impaction cases. In severe cases, endoscopy and surgery may be necessary. Case presentation: A 78-year-old Han Chinese man living in a nursing home was diagnosed with fecal impaction; his initial symptom was overflow diarrhea, which is a rare occurrence with regard to fecal impaction. Nevertheless, we were able to effectively treat this situation by employing a new medical device that presents a novel method for addressing fecal impaction. Conclusion: Early identification of fecal impaction with atypical symptoms is crucial to provide proper emergency management. A safe and noninvasive treatment method, especially for elderly patients with fecal impaction, should be chosen. [ABSTRACT FROM AUTHOR]

Abstract Background Fecal impaction is a digestive system disease, that is most common in the elderly population and becomes more prevalent with increasing age. Manual removal can successfully remove the impaction in 80% of fecal impaction cases. In severe cases, endoscopy and surgery may be necessary. Case presentation A 78-year-old Han Chinese man living in a nursing home was diagnosed with fecal impaction; his initial symptom was overflow diarrhea, which is a rare occurrence with regard to fecal impaction. Nevertheless, we were able to effectively treat this situation by employing a new medical device that presents a novel method for addressing fecal impaction. Conclusion Early identification of fecal impaction with atypical symptoms is crucial to provide proper emergency management. A safe and noninvasive treatment method, especially for elderly patients with fecal impaction, should be chosen.

Abstract Background Stercoral colitis (SC) is a rare but potentially life-threatening inflammatory colitis caused by the accumulation of impacted fecal material. Despite reported associations with bowel perforation and high mortality rates, stercoral colitis remains a poorly defined and underrecognized diagnosis in the emergency department (ED). Objective of the review This review aims to summarize and synthesize existing literature on SC to guide its recognition and management in the ED. Discussion SC primarily occurs in elderly or bedbound patients with chronic constipation; however, it does occur in younger patients with comorbidities at increased risk for fecal impaction. Patients may present acutely with abdominal pain and distension, but clinical presentation is often nonspecific and varied, and there are no established diagnostic criteria for SC to date. CT is therefore crucial for diagnosis, revealing key findings such as fecaloma, colonic dilatation, and fat stranding. Treatment depends on severity of illness, ranging from manual disimpaction and other conservative measures for most cases, to surgical intervention for complicated cases, such as stercoral perforation. Conclusions SC can be a challenging diagnosis in the ED, often requiring multidisciplinary collaboration. Timely recognition and appropriate treatment are essential to reduce morbidity and mortality associated with this condition. Further research is needed to establish diagnostic criteria and clear management algorithms.

Purpose: This study synthesized the literature on constipation among Korean older adults in longterm care (LTC) facilities. Methods: This scoping review utilized the Joanna Briggs Institute protocol. We conducted a literature search using Cumulative Index to Nursing and Allied Health, PubMed, PsycINFO, Korean databases Research Information Sharing Service, Korean Studies Information Service System, and ScienceON. Two reviewers independently selected the studies and extracted their characteristics using pretested forms to determine the final inclusion. In total, 473 articles were identified, and eight were used for the final analysis. Results: Quasi-experimental design was the most common research design. Sex, age, state of mobility, admission periods, LTC classification, sleep satisfaction, depressive symptoms, diet type, daily fluid intake, and history of digestion were identified as factors related to constipation. The most widely used constipation measurement method is measuring the frequency of defecation per week. Massage is the most commonly used nursing intervention to relieve constipation. Conclusion: The diversification of research on constipation is necessary to improve the quality of life of older adults living in LTC facilities. Therefore, the use of reliable tools to determine constipation in older adults in LTC facilities should be expanded. There is a need to develop and implement diverse non- pharmacological interventions for older adults in LTC facilities. The results of this study are intended to serve as a basis for the development of constipation programs for Korean older adults in LTC facilities. [ABSTRACT FROM AUTHOR]

A stercoral rectal perforation is an uncommon cause of acute abdominal pain with only limited cases documented in medical literature. Timely and accurate imaging is essential when this condition is suspected, and immediate surgical intervention is imperative upon confirming the diagnosis of bowel perforation. Usually, the definitive diagnosis of a stercoral rectal perforation is established intraoperatively and a Hartmann procedure with (temporary) end colostomy is performed. In this case report, we present our first-hand experience in managing a stercoral rectal perforation, highlighting the importance of early diagnosis and rapid surgical intervention to achieve favorable outcomes. [ABSTRACT FROM AUTHOR]

Objectives This study evaluated the efficacy of Polyethylene glycol 4000 for fecal disimpaction in children with cerebral palsy. Materials & Methods A randomized control trial study was conducted on children with cerebral palsy between February -- March 2017 in the pediatric neurology outpatient clinic Dr. Soetomo Hospital. Children aged 2-16 years with fecal impaction randomly assigned into polyethylene glycol 4000 (PEG 4000) and saline enema group. Polyethylene glycol 4000 was given at a dosage of 0.7 g/kg and enema using normal saline 15ml/kg twelve hourly. Constipation was diagnosed using ROME IV criteria, and abdominal palpation identified fecal impaction. Efficacy was evaluated by clinical observation and adverse symptom monitoring. Data were analyzed by statistical software using an independent t-test (p<0,05). Results Thirty-two children were randomized into the study. Muscle relaxant was discovered in 17/32 patients. Sex, age, and body weight were not statistically different between groups. The resolution of fecal impaction was significantly different between PEG 4000 and saline enema (21.69 hours and 39 hours respectively; p=0.001). Application of muscle relaxant and severity of the disease did not involve treatment efficacy. There was no adverse symptom reported during treatment. Conclusion Polyethylene glycol 4000 results in fecal disimpaction faster than enema in constipated children with cerebral palsy. [ABSTRACT FROM AUTHOR]

Intussusception involving the colon is unusual in adults and when present is managed with resection due to the risk of malignancy. We present an unusual case where the intussusceptum was impacted stool in a mucosal pouch in the transverse colon. The patient presented with bleeding per rectum and abdominal pain and was found to have a colocolic intussusception on computed tomography. Colonoscopy showed an ulcerated mass in the transverse colon. A laparoscopic right hemicolectomy was performed. Histopathology demonstrated known chronic lymphocytic leukemia, but not solid malignancy. A large fecalith impacted within a mucosal pouch had acted as the lead point. This represents a highly unusual but benign cause of intussusception.

An appendicovesical fistula is defined as an abnormal communication between the appendix and the urinary bladder, with only a few cases reported in the literature. It is very challenging to make an early diagnosis, due to the inability of conventional imaging modalities to detect this unique pathology. The symptoms are often mild, and there are not any specific signs or symptoms that might suggest this type of anomalous communication. We report a case of a 27-year-old male patient who presented difficulty for initiating urination, dysuria, and persistent urinary tract infections. An abdominal x-ray showed a large calculus inside the bladder. A cystoscopy was performed, where the tip of the appendix was seen protruding inside the bladder with a large fecalith adhered to the bladder wall. An appendectomy and partial cystectomy with primary repair were auspiciously achieved. A review of the literature is also presented.

Chronic constipation is a frequent symptom encountered in the daily clinical practice. The treatment of this condition mainly relies on the use of laxatives. However, patients' satisfaction with this approach is limited, and alternative measures are often added to the treatment. Among these, particularly frequent worldwide is the use of enemas, even though literature data on its scientific validity are scarce. In this article, by an extensive online search of Medline (through PubMed), Scopus, Cochrane CENTRAL, EMBASE, and the Science Citation Index, the available literature data on the use of enemas in adult patients with chronic constipation, also in the perspective of available guidelines on treatment of this pathological condition, were analyzed. Although the use of enemas remains a frequently employed method and it is considered as useful by many physicians as an adjunctive support for the treatment of chronic constipation in adults, this practice is not substantiated by rigorous scientific data, and some studies are available only for specific instances (fecal impaction, transanal irrigation). Thus, waiting for more robust scientific data, enemas treatment should be carried out on an individual patient's basis, according to the experience of the caring physicians. [ABSTRACT FROM AUTHOR]

Purpose: To describe and update stercoral colitis clinical risk factors, relative frequency, location, and CT imaging features correlated with surgical and pathological results. Methods: CT reports over a 5-year period (05/2017–05/2022) at a single medical center were searched. Main inclusion criteria were luminal distention with formed stool, wall thickening, and surrounding inflammation. Positive cases were graded as mild (early or developing stercoral colitis) versus moderate-to-severe based on CT findings. Medical records were reviewed for risk factors and outcome data in moderate-to-severe cases. P-values were tabulated for comparison. Results: 545 total cases (71 (60, 82) years, 278 males) were identified on CT, including 452 mild (82.9%) and 93 moderate-to-severe cases (17%, 67 (55, 79) years, 48 females). Twenty cases showed evidence of perforation (3.7% total cohort, 22% moderate-to-severe cohort). Diagnosis as an incidental finding was frequent (46.0% of mild cases). Most cases involved the rectum (97.6% of mild cohort and 69% of moderate-to-severe cohort). The sigmoid was involved in 31% of moderate-to-severe cases, but 95% of the perforated subcohort (19/20, 13/20 without rectal involvement). Among the moderate-to-severe cohort, perforation was associated with slightly increased wall thickness (6.4 vs. 5.7 mm, p = 0.03), opioid use (50 vs. 23%, p = 0.04), and disease-specific mortality (11 vs. 0%, p =0.04). Perforation was less associated with major neurocognitive disorders (20 vs. 60%, p = 0.003), institutionalized status (5 vs. 38%, p = 0.005), and a prescribed bowel regimen (30 vs. 63%, p = 0.01). Conclusion: Stercoral colitis may be under-reported. Perforation tends to favor sigmoid involvement and a less traditional patient cohort. [ABSTRACT FROM AUTHOR]

Functional fecal incontinence or encopresis is a condition commonly seen in children, and as such, pediatricians and health care providers who care for children should be familiar with this diagnosis. Encopresis refers to the passage or leakage of feces in inappropriate settings. There is a high prevalence of associated behavioral symptoms in children who have encopresis. Treatment involves patient and family education, behavioral strategies for stool regulation, disimpaction of stool in children who have constipation, and long-term maintenance of regular bowel habits. This discussion reviews the definition, epidemiology, clinical presentation, and treatment of children who have encopresis. [ABSTRACT FROM AUTHOR]

Purpose Perineal procedures are an important surgical option for frail and high-risk patients with rectal prolapse. This study aimed to evaluate the efficacy and safety of combined therapy using injection sclerotherapy, with aluminum potassium sulfate and tannic acid (ALTA), and the Thiersch procedure, using the Leeds-Keio ligament (ALTA-Thiersch). Methods This study included 106 consecutive patients (mean age, 81.2 years) who underwent ALTA-Thiersch for rectal prolapse. The procedure was performed under caudal epidural anesthesia. ALTA was injected into the submucosa from the tip of the prolapsed rectum down to the dentate line, circumferentially, at 20 to 40 locations. The ligament tape was placed outside the external sphincter muscle and at an approximate depth of 2 cm into the middle anal canal. Results Of 106 patients, rectal prolapse was cured shortly after surgery in 105 patients. An additional tape was inserted in 1 patient who had persistent prolapse. Postoperative complications were observed in 27 patients (25.5%). Fecal impaction occurred in 12 patients; however, since it was temporary, no tape removal was required. Of the 12 cases in which the tape was infected or exposed, 11 required tape removal. There were 18 cases of recurrence at a mean follow-up of 22.1 months. Cumulative recurrence rates at 3 and 5 years were 21.3% and 38.6%, respectively. Conclusion ALTA-Thiersch is a simple and safe procedure for rectal prolapse, having reasonable outcomes. The use of the Leeds-Keio ligament for anal encircling can help compensate for the disadvantages of the Thiersch operation.

Fecal impaction is a common digestive disorder and is considered an acute complication of chronic and untreated constipation. Generally, the factors responsible for fecal impaction are similar to those associated with constipation. Early identification and treatment minimize complications and patient discomfort. Common treatment options to address fecal impaction of the rectum include manual disimpaction or fragmentation, the use of distal and/or proximal softening or washout procedures such as enemas and suppositories, and oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes. In severe cases, surgical intervention is necessary. Post-treatment evaluation should include a colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves. Following treatment, conduct an evaluation of causes and create a preventive therapy plan. [ABSTRACT FROM AUTHOR]

Dropped appendicolith following an appendectomy is a rare complication which may occur as a consequence of appendicolith expulsion from the appendix due to a previous perforation or failure to identify the appendicolith. A fecalith generally becomes symptomatic over time, as a result of abscess formation, intestinal obstruction, fistula tract or inflammation of the appendiceal stump. Two cases of dropped appendicolith following an appendectomy are described hereinbelow. Case 1: A 23-year-old female patient, who underwent an appendectomy the previous day, was admitted to the emergency room due to hypogastric pain. A computed tomography (CT) scan revealed a dropped appendicolith in the right iliac fossa, and a diagnostic laparoscopy showed intra-abdominal abscesses and a dropped appendicolith in the appendicular stump. Case 2: A 77-year-old male patient, who underwent surgery for acute appendicitis caused by appendicoliths, showed abdominal distension on the sixth postoperative day. The CT scan revealed intestinal obstruction and a dropped appendicolith at bowel loops. In the surgical reintervention, erosion of the mesentery caused by the appendicolith was evidenced. Both patients progressed after the reoperations. The incidence of dropped appendicolith following an appendectomy is currently unknown since few data are available in the literature worldwide. Therefore, it is important to present these cases to expand the casuistry, learn more about dropped appendicoliths following an appendectomy, demonstrate their complications if they are not removed early and show how to prevent them. In conclusion, dropped appendicoliths following an appendectomy must be removed early to avoid complications. [ABSTRACT FROM AUTHOR]

In contrast to conventional commercial poultry, which are raised primarily in controlled indoor environments, backyard poultry are typically raised in less restricted settings, potentially exposing them to a greater variety of ingestible substances, including multiple types of forage. Consequently, problems such as gastrointestinal impactions caused by ingesta have been noted in backyard poultry. To determine the prevalence of these impactions in backyard poultry, we performed a retrospective database search for autopsy submissions to the California Animal Health and Food Safety laboratory system and found that gastrointestinal impaction was associated with the death of 42 backyard poultry cases (40 chickens, 1 turkey, and 1 goose) from January 2013 to July 2018. In 32 of these 42 (76%) cases, the impaction was caused by fibrous plant material, 7 (17%) by compacted feed, and 3 (7%) by miscellaneous ingesta (tortilla, plastic, and wood shavings). The large proportion of grass impactions indicate that foraging is the predominant source of impaction material in backyard poultry, and that long grasses may be a significant health hazard for poultry. Backyard, pasture-raised, and free-range poultry producers are advised to maintain short pastures, avoid feeds that may expand in the gastrointestinal tract, and provide adequate grit to prevent impactions.

Background: Despite acute appendicitis is one of the most common surgical emergencies, its aetiology remains incompletely understood. Aim: This study aimed to assess the rate at which faecoliths were present in acute appendicitis treated with appendicectomy and whether their presence was associated with complicated appendicitis. Methods: All adult patients who underwent appendicectomy for acute appendicitis in a 2 years period (January 2018 and December 2019) at a single institution were retrospectively reviewed. The presence of a faecolith was identified by at least one of three methods: pre-operative CT scan, intraoperative identification, or histopathology report. Patients were grouped according to the presence or absence of a faecolith and demographics, type of appendicitis and surgical outcomes analysed. Complicated appendicitis was defined as appendicitis with perforation, gangrene and/or periappendicular abscess formation. Results: A total of 1035 appendicectomies were performed with acute appendicitis confirmed in 860 (83%), of which 314 (37%) were classified as complicated appendicitis. Three hundred thirty-nine (35%) of the appendicitis cases had faecoliths (complicated 165/314 cases; 53%; uncomplicated 128/546; 23%, p < 0.001). The presence of a faecolith was associated with higher complications and a subsequent longer post-operative stay. Conclusion: The rigorous methodology of this study has demonstrated a higher rate of faecolith presence in acute appendicitis than previously documented. It reinforces the association of faecoliths with a complicated disease course and the importance in prioritising emergency surgery and postoperative monitoring for complications. [ABSTRACT FROM AUTHOR]

This case series was completed to determine the effectiveness of an interdisciplinary (occupational and physical therapy) approach to treating constipation and fecal incontinence in children. Non-pharmacological therapies for treating constipation and incontinence are showing potential benefits, especially for children not responding to standard medical treatment, which involves oral laxatives for fecal dis-impaction (cleanout) and maintenance dosing to prevent further impaction. A retrospective chart review, surface electromyography (sEMG) biofeedback, and parent and child reports of progress was completed for two children ages 4 and 10 years old. Progress toward goals was measured using a therapy plan of care and progress updates every 60 days. Focus of goals included, pelvic floor muscle coordination and activation, education of anatomy and physiology of digestive system, emotional regulation, functional training in the bathroom, and hygiene. Notable improvements in pelvic floor function, emotional regulation, and defecation dynamics contributed to decreased constipation and fecal incontinence as well as improved emotional regulation and confidence in both participants over a 6-month period. A coordinated physical therapy and occupational therapy approach to treating children with constipation and fecal incontinence can be successful in reaching full continence and support children have not responded to standard medical treatment. [ABSTRACT FROM AUTHOR]

Constipation is one of the most common pediatric entities that the pediatrician sees in daily consultation. It is functional in 90-95% of cases. The diagnosis of constipation is based on the Rome IV criteria. Divided according to age group, in infants and toddlers under 4 years of age and in children and adolescents between 4-18 years of age. The treatment consists of a disimpaction stage and a maintenance stage with medical treatment, which includes 5 main classes of laxatives: mass formers, stimulants, osmotics, emollients and secretagogues. Regarding commonly used therapies, they include polyethylene glycol 3350 (PEG), sennosides, lactulose, milk of magnesia, among others. There is no evidence on the association between increased fluid intake, fiber treatment, use of probiotics and improvement in constipation. The aim of this chapter is to learn about new constipation therapies that have been approved in adults such as lubiprostone, linaclotide, tegaserod and prucalopride. [ABSTRACT FROM AUTHOR]

Summary: In this case report, we present a rare case of life‐threatening gastrointestinal haemorrhage associated with deranged coagulation due to supratherapeutic levels of dabigatran. Dabigatran is a potent, synthetic, reversible non‐peptide thrombin inhibitor which is increasingly used for stroke prevention in patients with non‐valvular atrial fibrillation. It is generally accepted that dabigatran dosing does not require titration or the monitoring of plasma levels due to its predictable pharmacokinetics and pharmacodynamics. However, this case report challenges this viewpoint while identifying an important knowledge gap in relation to the effect of altered gastrointestinal motility on the absorption of direct oral anticoagulants. Furthermore, it demonstrates the successful use of high‐dose idarucizumab in a critical care setting. Idarucizumab is a monoclonal antibody fragment that binds specifically to dabigatran and its metabolites, thereby reversing the anticoagulant effect. [ABSTRACT FROM AUTHOR]

The inability to pass stool for a prolonged period can lead to the formation of fecaliths, which occurs most often in the colon or rectum. Although large fecaliths can lead to serious or life-threatening complications, the detailed process of their formation is unknown. This report describes a 65-year-old woman who presented with melena due to ischemic proctitis caused by a large fecalith. On computed tomography, the fecalith showed a unique multilayered calcification sign. We successfully dismantled and removed the fecalith transanally, assisted by a traction method using a balloon catheter. A review of imaging studies from 6 years ago revealed the growth of the fecalith over the previous year and provided an insight into the mechanism underlying the development of large fecaliths.

Pneumatosis intestinalis or abnormal intramural gas within the digestive tract usually suggests bowel ischemia necessitating urgent surgery. We report the case of an 82-year-old female presenting with hypotension and nausea, with a past history of schizophrenia, low grade chronic lymphocytic leukemia, stroke, bronchitis and rheumatoid arthritis. Computed tomography performed demonstrated extensive submucosal gas within the entire small bowel, associated with free gas in the peritoneal cavity. Bowel ischemia was diagnosed radiologically. However, a benign diagnosis of fecal impaction was ultimately made due to the patient's stable clinical status. Clinical correlation and close monitoring of clinical status in this context is of greatest diagnostic assistance when encountered with this phenomenon, to prevent unnecessary harm to the patient.

Stercoral perforation of the colon is a rare and life-threatening condition caused by pressure necrosis due to fecal impaction. It is commonly associated with chronic constipation, particularly in patients with neurogenic bowel disorders or prolonged opioid use. However, its occurrence in the context of chronic heroin use is rarely reported. We report the case of a 40-year-old male with a 5-year history of heroin abuse who presented with diffuse abdominal pain, vomiting, and cessation of gas and stool passage for 10 days. Physical examination revealed a distended abdomen with generalized tenderness, guarding, and a rectal examination confirmed fecal impaction. Computed tomography (CT) showed massive fecal impaction in the sigmoid colon with pneumoperitoneum, indicating perforation. The patient underwent urgent exploratory laparotomy, revealing two perforations in the sigmoid colon with extensive fecal peritonitis. A segmental resection of the sigmoid colon with colostomy was performed. Postoperatively, the patient required intensive care for septic shock but eventually recovered and was referred to an addiction treatment program. This case highlights the serious gastrointestinal complications associated with chronic opioid use, particularly heroin. The pathophysiology involves opioid-induced inhibition of gastrointestinal motility, leading to chronic constipation, fecaloma formation, and subsequent perforation. Early recognition and prompt surgical intervention are crucial in managing stercoral perforation, which carries a high mortality rate if delayed. This case underscores the importance of recognizing gastrointestinal risks in chronic opioid users, especially heroin, and the need for integrated care strategies to prevent severe complications like stercoral perforation. • Stercoral perforation is a rare, life-threatening condition linked to chronic heroin use. • Heroin-induced constipation can lead to severe fecal impaction and bowel perforation. • Prompt CT imaging and surgical intervention are crucial for managing stercoral perforation. • This case highlights the need for awareness of gastrointestinal risks in opioid users. • Integrated care is vital to prevent severe complications from opioid-induced constipation. [ABSTRACT FROM AUTHOR]

Abstract Background Constipation during pregnancy is not uncommon. Usually, this does not warrant extensive evaluation and settles with minor interventions or lifestyle modifications. Severe fecal impaction in chronically constipated patients can rarely lead to obstructive uropathy. Relief of obstruction can result in a diuretic phase which may be self-limiting or pathological. However, occurrence of pathological post-obstructive diuresis as a result of severe constipation is an extremely rare complication during pregnancy and puerperium which can even be fatal if not promptly diagnosed and adequately monitored and timely intervened. We describe the management of a pathological post-obstructive diuresis which occurred in the immediate postpartum period after treatment of severe constipation and obstructive uropathy. Case presentation A woman who had undergone an emergency caesarean section due to deep transverse arrest 1 week ago, presented with fecal impaction and anuria. On relief of urinary obstruction which had developed secondary to fecal impaction, she developed pathological post-obstructive diuresis. Careful and timely monitoring with exact fluid replacement, correction of electrolyte imbalances and multidisciplinary care ensured complete recovery of the patient. Conclusions Despite obstructive uropathy being uncommon in obstetric practice, clinicians need to have a high index of suspicion to monitor and promptly manage the potentially life-threatening condition of post-obstructive diuresis in pregnant and puerperal women undergoing urinary tract decompression. Due to unreliability of laboratory cutoff values in pregnancy and puerperium, a more vigilant and multidisciplinary approach with lower threshold for intervention is more prudent in the management of these patients.

Traditionally, large bowel obstruction (LBO) can be due to a neoplasm, most often colorectal cancer. Also, fecal impaction (FI) is a common disease, which occurs in a variety of ages and is significantly increased in the elderly. This case report is of LBO caused by FI, in which ultrasonography (US) proved to be useful for diagnosis and follow-up. A 60-year-old female had abdominal pain after taking a laxative as part of bowel preparation for colonoscopy. The US diagnostic findings were a marked dilation of the bowel, due to watery stool, in the ascending colon, and a clear FI, in the descending colon. Computed tomography showed similar findings to the US. There was a large amount of defecation after treatment and US demonstrated an improvement in the ileus. Ten days after admission, a colonoscopy revealed no stenosis or tumor, as a cause for the ileus. [ABSTRACT FROM AUTHOR]

Stercoral colitis is a rare inflammatory condition involving the large bowel wall secondary to fecal impaction. Stercoral colitis has a clinical course ranging from non-complicated fecaloid impaction to colonic perforation. This case report aims to give a brief review of this condition and discuss its imaging findings. Case Presentation: We herein report a case 74-year-old female who presented with abdominal pain, abdominal distension, and the absence of gas-feces discharge for a few days. The patient had a one-year history of chronic constipation and recent femoral neck fracture surgery. Physical examination shows abdominal distension with slight tenderness. Abdominal radiographs demonstrated bowel distention and fecal material in the colorectal regions. Computed tomography (CT) images demonstrated abundant fecal material with massive dilatation in the rectosigmoid colon, focal mural thickening, subtle pericolic fat stranding, and minimal free fluid in the abdominal and pelvic cavities. Based on these findings, the diagnosis of stercoral colitis was made. The patient was treated conservatively and eventually discharged with a good health condition. Conclusion: Stercoral colitis seems to be more common in elderly patients with comorbid diseases. Chronic constipation causing fecal impaction is a major risk factor. CT scan is the most helpful imaging modality for the diagnosis of stercoral colitis. CT findings that should prompt the radiologist to consider this diagnosis include colonic dilatation containing impacted feces, mural thickening, and pericolic fat stranding. If the fecal impaction is not promptly relieved, life-threatening complications such as colonic perforation can occur.

The article describes the case of an eight-year old girl with history of chronic constipation and a calcified abdominal mass and diagnosed with Hirschsprung's disease. It discusses clinical findings on the patient's anorectal manometry, computed tomography and colonoscopy and details of her conditions of fecaloma and delayed passage of meconium. The patient underwent laparoscopic colostomy, laparoscopically assisted Soave endorectal pull-through with loop ileostomy and ileostomy closure.

The inability to pass stool for a prolonged period can lead to the formation of fecaliths, which occurs most often in the colon or rectum. Although large fecaliths can lead to serious or life-threatening complications, the detailed process of their formation is unknown. This report describes a 65-year-old woman who presented with melena due to ischemic proctitis caused by a large fecalith. On computed tomography, the fecalith showed a unique multilayered calcification sign. We successfully dismantled and removed the fecalith transanally, assisted by a traction method using a balloon catheter. A review of imaging studies from 6 years ago revealed the growth of the fecalith over the previous year and provided an insight into the mechanism underlying the development of large fecaliths. [ABSTRACT FROM AUTHOR]

Background: Aging may affect ascending colon (AC) differently from descending colon (DC) and increase the risk of fecal loading (FL) in AC. Methods: Patients aged ≥65 years admitted to a community hospital were analyzed by abdominal x‐ray for fecal loads and stool retention patterns. FL was scored between 0 and 5 (severe) on each segment of colon with a possible total score 20. Mean segment scores ≥3.5 were designated as high scores for both AC and DC. Logistic regression was performed between groups to identify factors associated with FL patterns. Results: Groups identified were high FL in both AC and DC (N = 21, 17.2%), FL predominantly in AC (N = 38, 31.1%), low FL in both AC and DC (N=60, 49.2%), and FL low in AC and high in DC (N = 3, 2.5%). Among 71 patients with total FL scores ≥13 (indicating significant stool retention), 37 (52.1%) had the FL predominantly in AC. Patients prescribed antibiotic(s) prior to hospitalization had lower odds of FL predominantly in AC (adjusted odds ratio = 0.18, 95% confidence interval = 0.04–0.84) compared to the group of low FL in both AC and DC with the adjustment of confounders. Conclusion: This study found that 52.1% of those with significant stool retention on x‐ray had the FL predominantly in AC. Antibiotic use was associated with lower odds of having FL predominately in AC. This study provided insights of FL distribution in colon and AC could be an area for significant stool burden in older adults with stool retention. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was o define the preoperative diagnostic clinical and radiological features in girls with congenital pouch colon (CPC). Materials and Methods: Records of 47 girls with CPC, managed from 1996 to 2018, were reviewed. There were two age groups: Group A (newborn to 12 months; n = 26) and Group B (>12 months to 20 years; n = 21). The important clinical and radiologic features to help in a preoperative diagnosis were noted. Results: The most common subtype was Type II (57.4%), followed by Type I (23.4%) and Type III (12.8%). The features common to both the groups were abdominal distension (A = 53.8%; B = 9.52%), severe perineal excoriation (A = 19.2%; B = 23/8%), and urinary incontinence (A = 30.7%; B = 85.7%). In addition, in Group B, fecaloma on abdominal palpation was noted in 28.6% of patients. The characteristic appearance of the perineum including external genitalia and findings on plain abdominal X-ray (AXR) were 100% accurate and hence diagnostic. These unique features helped us formulate an algorithm for preoperative diagnosis of this uncommon form of anorectal malformation in girls seen in North India. Conclusions: The characteristic features on clinical examination should alert one to the presence of CPC in the outpatient clinic. The AXR was diagnostic in 100% of cases and is mandatory. If any doubt persists, examination of the genitalia under anesthesia with more retraction of the labial folds and endoscopy can be performed for confirmation. These measures should enable a clinician to make an accurate preoperative diagnosis in every girl with CPC. [ABSTRACT FROM AUTHOR]