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 Table of Contents  
LETTER TO THE EDITOR
Year : 2014  |  Volume : 19  |  Issue : 2  |  Page : 166-167

Fecaloma in a neglected case of anorectal malformation


Departments of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India

Date of Web Publication11-Aug-2014

Correspondence Address:
Umesh C Parashari
Department of Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9903.138448

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How to cite this article:
Parashari UC, Khanduri S, Singh N, Bhadury S. Fecaloma in a neglected case of anorectal malformation. J Mahatma Gandhi Inst Med Sci 2014;19:166-7

How to cite this URL:
Parashari UC, Khanduri S, Singh N, Bhadury S. Fecaloma in a neglected case of anorectal malformation. J Mahatma Gandhi Inst Med Sci [serial online] 2014 [cited 2020 Jul 5];19:166-7. Available from: http://www.jmgims.co.in/text.asp?2014/19/2/166/138448

Sir,

We encountered a case of fecaloma in a 20-year-old female with anorectal malformation who presented to our hospital with complaints of abdominal pain and distension with a long history of constipation for which she took symptomatic treatment. When examined a smooth, mobile, nontender, firm abdominal mass filling almost whole of the abdomen was observed with absent bowel sounds on auscultation. No palpable stool was noted on rectal examination, but anorectal malformation with hypoplastic anal canal and rectovaginal fistula was observed. Previously, she had a history of passage of small amount of stool per vaginum and history of some operation in the neonatal period.

Plain X-ray abdomen revealed an intra-luminal radiolucent mass with laminated calcification having smooth contour with no obvious mucosal attachment. On ultrasonography, a large calcified lesion filling almost whole of the abdomen with thick posterior acoustic shadowing causing pressure effect over surrounding organs was noted. Non-contrast computed tomography (CT) and contrast-enhanced CT abdomen showed dilated sigmoid filled with intra-luminal densely calcified fecal residue that appeared organized, round, well-defined, and laminated [Figure 1]. Thus, the diagnosis of fecaloma was made. Patient was managed conservatively which lead to the disappearance of calcified fecaloma, however, dilatation of bowel persisted which also subsided within due course of time [Figure 2]. Magnetic resonance imaging of the lower abdomen revealed evidence of hypoplastic sacrum with hypoplastic anal canal, thinned out anorectal sling and recto-uterine and recto-vaginal fistula [Figure 3] and [Figure 4]. Following it, the patient was treated for recto-vaginal fistula surgically. Patient gradually improved with no recurrence leading a completely healthy life.
Figure 1: A noncontrast computed tomography of abdomen shows dilated sigmoid filled with well-defined intra-luminal densely calcified rounded and laminated fecal residue (white arrow)

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Figure 2: Contrast-enhanced computed tomography of abdomen performed after multiple bowel washes showing disappearance of calcified fecaloma, however, dilatation of bowel persists (white arrow)

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Figure 3: Axial T2-weighted magnetic resonance imaging of lower abdomen (a and b) show hypoplastic sacrum with hypoplastic anal canal, thinned out anorectal sling,recto-uterine and recto-vaginal fistula (white arrow)

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Figure 4: Sagittal T2-weighted magnetic resonance imaging of lower abdomen in confirms the findings of figure 3 and shows hypoplastic sacrum and anal canal, thinned out anorectal sling, recto-uterine and recto-vaginal fistula (white arrow)

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Fecaloma is hardening of feces into lumps of varying sizes which is harder than the fecal impaction [1] inside the colon and is most commonly seen in rectum [2] or distal colon and rarely in caecum. [3] Symptoms are most often nonspecific such as constipation, weight loss, and vague abdominal discomfort after meals. It is sometimes associated with conditions such as Chagas disease, Hirschsprung's disease, and psychiatric disorders. [4],[5] The mass is usually composed of fecal matter with intestinal debris. [1] The mass has smooth margins with some mobility within bowel lumen and is not attached to the mucosal surface. [3],[4] Diagnosis of fecaloma is usually made radiologically from a characteristic intra-luminal mass seen on plain X-rays, barium enema, and abdominal CT. [3],[4] The complications of fecaloma include obstruction, ulceration, bleeding, perforation of colon, and hydronephrosis. [1] Treatment is mostly done on conservative lines, which include enemas, laxatives, rectal evacuation. [2] However when the conservative management fails, surgical intervention or endoscopic [1] removal is used.

This is an unusual case of fecaloma because it is a delayed complication of poorly repaired congenital anovestibular fistula in a young female. The case is important because it gives us the insight that fecaloma must be considered in the differential diagnosis in a case of chronic constipation with a lump in the abdomen.

 
  References Top

1.Garisto JD, Campillo L, Edwards E, Harbour M, Ermocilla R. Giant fecaloma in a 12-year-old-boy: A case report. Cases J 2009;2:127.  Back to cited text no. 1
    
2.Rajagopal A, Martin J. Giant fecaloma with idiopathic sigmoid megacolon: Report of a case and review of the literature. Dis Colon Rectum 2002;45:833-5.  Back to cited text no. 2
    
3.Cid AA, Pietruk T, Bidari CZ, Ehrinpreis MN. Cecal fecaloma mimicking colonic neoplasm. Dig Dis Sci 1981;26:1134-7.  Back to cited text no. 3
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4.Kantarci M, Fil F. Education and imaging. Gastrointestinal: Fecaloma in a dilated sigmoid colon. J Gastroenterol Hepatol 2007;22:955.  Back to cited text no. 4
    
5.Kim KH, Kim YS, Seo GS, Choi CS, Choi SC. A case of fecaloma resulting in the rectosigmoid megacolon. Korean J Gastrointest Motil 2007;13:81-5.  Back to cited text no. 5
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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