1/8. fecal impaction causing megarectum-producing colorectal catastrophes. A report of two cases.PURPOSE: Massive fecal impaction leading to surgical catastrophes has rarely been reported. We present 2 such patients to remind physicians that neglected accumulation of fecal matter in the rectum may lead to ischemia and perforation of the colon and rectum. methods: Report of 2 patients and a medline search of the literature. RESULTS: In the 1st case massive fecal impaction produced an abdominal compartment syndrome and rectal necrosis. In the 2nd patient fecal impaction resulted in colonic obstruction and ischemia. In both, an operation was life-saving. CONCLUSION: Neglected fecal impaction may lead to a megarectum causing an abdominal compartment syndrome and colorectal obstruction, perforation or necrosis. Measures to prevent fecal impaction are of paramount importance and prompt manual disimpaction before the above complications develop is mandatory. Appropriate operative treatment may be life-saving.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Abdominal compartment syndrome in a patient with congenital megacolon.A 13-year-old male with a history of chronic congenital megacolon presented to the emergency department with a 1-day history of increasing abdominal pain, distension, and emesis. The patient was admitted for bowel disimpaction and irrigation. The patient rapidly developed an acute abdominal compartment syndrome because of his massive colonic dilation. Surgical decompression resulted in a reperfusion phenomenon and ultimately resulted in coagulopathy and patient demise. This case presents a unique cause of the abdominal compartment syndrome and discusses the implications to the emergency physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. megacolon: constipation or volvulus?Pediatric abdominal complaints are common presentations in emergency departments, and emergency physicians are challenged every day with a vast array of gastrointestinal disorders. Differentiating the child with a benign abdominal process from the child with a more serious condition can be difficult. We report a case of massive dilatation of the colon due to fecal impaction. Means for distinguishing constipation from alternative diagnoses are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Hirschsprung's disease in adolescents. Misadventures in diagnosis and management.Three male adolescents, ages 13, 15, and 17 years, presented with complications of their Hirschsprung's disease, including acute enterocolitis with sepsis, chronic enterocolitis with anemia and leukocytosis, and severe fecal impaction. All had experienced delay in diagnosis resulting from either physician error in diagnosis or physician misinformation concerning the surgical treatment of the disease. These three patients illustrate some of the pitfalls in the diagnosis and surgical management of patients with Hirschsprung's disease. Misinformation concerning the surgical correction of this disease still exists, and these patients emphasize the necessity of continued, updated information in the diagnosis, management, and outcome of patients with Hirschsprung's disease.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/8. The radio-opaque appendicolith--its significance in clinical practice.Four cases are reported, in whom radiologically opaque appendiceal coproliths (appendicoliths) were recognised on plain abdominal radiographs. These were undertaken for diagnostic purposes, in patients with right-sided abdominal pain, in whom the diagnosis was not immediately apparent. The pathology, radiological features, and clinical significance of the phenomenon are discussed, and the association of appendicoliths with appendiceal perforation and gangrene is stressed. The fact that clinical signs and symptoms of acute appendicitis are often misleading and sometimes minimal, even in the presence of severe local peritoneal infection is of importance to physicians as well as surgeons.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. fecal impaction as a cause of acute lower limb ischemia.Acute lower extremity ischemia secondary to fecal impaction has not been previously reported. Herein, we report the case of an elderly man who was referred to our medical center with an acutely ischemic right lower extremity and a possible abdominal aortic aneurysm. The suspicious abdominal mass noted by his local physician was found to be a large fecal impaction of the rectosigmoid which, by direct pressure, was compressing and occluding the right common iliac artery. After disimpaction, there was complete resolution of the vascular symptoms and signs in the right lower extremity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. barium and fecal impaction: an unusual case of bilateral hydronephrosis.We present an interesting case report of the second adult female reported to suffer from bilateral ureteral hydronephrosis, secondary to a fecal impaction, and the first caused by complications from residual barium. This elderly patient suffers from many associated neurologic, bowel, and urinary tract problems; this case report demonstrates their close proximal relationship. Through ureteral stent placement and manual disimpaction of the barium fecaloma, the patient was able to recover her normal renal and bowel functions. Aided by the use of excellent figures, it is our intent to inform physicians that they should consider fecal impaction as a cause for bilateral ureteral hydronephrosis in predisposed patients, and also the necessity of purging the GI tract of residual barium following radiologic studies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. The myth of the fecalith.A radiographically demonstrated fecalith is widely considered a virtually pathognomonic sign of acute appendicitis. This case report describes a patient with a clinical presentation suggestive of appendicitis and a well-defined right lower quadrant fecalith who was found to have a normal appendix at surgery. This case calls into question the venerable dogma surrounding the fecalith and highlights the necessity for the physician to continue to rely on clinical judgment in making the diagnosis of appendicitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |