sigmoid colon with fecalith and dilated bowel loops
Constipation with fecal impaction is a common and
above the impaction. Evacuation of the fecalith was
u s u a l l y o v e r l o o k e d p r o b l e m . F e c a l o m a i s
attempted with failure. We decide to emergent laparotomy
frequently radiopaque and is usually seen at the
since her abdominal girth significantly increased the day
rectosigmoid colon.1 Causes of fecal impaction include
gender (women), socioeconomic status, low intake of
Emergency laparotomy showed the whole large bowel
dietary fiber, dehydration, immobility, alcohol ingestion,
was extremely distented. The sigmoid colon and rectum
anti-psychosis drugs, hypothroidism.2,3 In this report,
were markedly dilated, thickened, and very redundant
we present a case with anti-psychosis treatment who had
with a firm intraluminal mass. The bladder also was
complications secondary to fecalith impaction and needed
extremely distended (3 liters of urine aspirated during
the surgery) (Fig. 1-3). Since the patient has pelvic
anatomic abnormality, we could not dissect down to the
A 56-year-old woman presented with abdominal pain
A sigmoid colotomy was performed and all the calcified
and distention which started four weeks prior to admission
fecal mass were removed. After the removal of the
to our clinic. The relatives of the patient stated her
content the diameter of the sigmoid colon was more than
abdominal distention increased last ten days. A review
20 cm. The inside of the sigmoid colon and rectum was
of systems and physical examination showed a markedly
inspected to rule out any intraluminal pathology to
distended abdomen and deep vein thrombosis in the left
explain the fecalith impaction. Then Devine ostomy was
leg secondary to abdominal distention. She had a
prominent kyphoscoliosis. The patient with life long
constipation was living alone and her relatives gave the
history since she was unsociable. She was under treatment
of psychosis with Risperdal® (risperidone) and Largactil®
(Chlorpromazine hydrochloride) for 15 years. The patient
had tremors which is a known side effect of Risperdal
(Parkinson like effect). She was taking akineton
(Biperiden HCL) to prevent side effects of anti-psychotic
treatment. Her thyroid hormon levels were within normal
limits and there was no sign of any chronic metabolic
disease. The CT scan showed extremely distended
Figure 2. Distended bladder with 3 liters of urine and distendedtransverse colon.
performed. During the postoperative follow-up period,
a rectoscopy and biopsy of the rectum was performed
which did not show any additional findings to explain
the cause of impaction. Urologic evaluation did not show
any organic abnormality, too. The urinary retention is
considered due to medications. Now the patient is on
postoperative third month and waiting for colostomy
Figure 1. Extremely distended abdomen and deep vein
thrombosis in the left leg secondary to compression of fecalith-
Constipation with fecal impaction is a common and
usually overlooked problem. Fecaloma is frequently
constipating drugs, hypothroidism.2 She was under
treatment of psychosis with Risperdal® (risperidone)
and Largactil® (Chlorpromazine hydrochloride) for 15
years. The patient had tremors which is a known side
effect of risperdal (Parkinson like effect). She was taking
akineton (Biperiden HCL) to prevent side effects of anti-
psychotic treatment. The known intestinal and urinary
side effects of risperidone and biperiden are; constipation
and urinary retention.3 We could not find any reason for
her constipation other than these medications.5 Her
thyroid hormon levels were within normal limits, and
there was no sign of any chronic metabolic disease. Fecal
impaction may cause stercoral ulceration, bowel
obstruction and perforation, sigmoid volvulus, fecal
incontinence, rectal prolapse, urinary retention,
hydronephrosis, deep venous thrombosis, lower limb
ischemia, massive gangrene.4,7 Fecal impaction rarely
Figure 3. Extremely distended rectum and sigmoid colon with
requires surgical intervention but surgical intervention
may be needed for removal of the fecaloma in patients
radiopaque and is usually seen at the rectosigmoid colon.1
with complications such as bowel perforation and
Causes of fecal impaction include gender (women),
volvulus or if conservative measures fail, as in our
socioeconomic status, low intake of dietary fiber,
dehydration, immobility, alcohol ingestion, use of
1. Rajagopal A, Martin J. Giant fecaloma with
and fecal impaction: an unusual case of bilateral
idiopathic sigmoid megacolon: report of a case and
hydronephrosis. Am Surg 1995;61:709-13.Source: http://turkishcolonrectum.net/files/krh_dergisi/ZSRHQVA_5_KRHD_21_1_28_30.pdf
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