Faecaloma with cathartic bowel

Faecaloma: (Also known as fecoma, faecoma, fecaloma)

• An accumulation of inspissated faeces in the distal (sigmoid) colon or rectum.
• The mass of feaces is much harder than a fecal impactation due to coprostasis.
• The composition of the mass is heterogeneous. Faecalomas usually consist of faecal matter and intestinal debris formed in a laminated fashion due to deposits of calcium soaps in layers.

Aetiology

• Damage to the autonomic nervous system in the large bowel associated with
  • Chagas disease (inflammatory and neoplastic)
  • Hirschprung’s disease
• Psychiatric patients
• Patients suffering with chronic constipation and cathartic bowel syndrome

Clinical Presentation

• Symptoms of fecaloma are usually nonspecific.
• Most patients are adults and present with symptoms of
  • Overflow diarrhoea
  • Constipation
  • Weight loss
  • Vague abdominal discomfort after meals.
• Clinical examination can give the appearance of an abdominal tumour

Complications

• Bowel obstruction and ulceration
• Bowel perforation (stercoral perforation)
• Hydronephrosis
• Rectosigmoid Megacolon
• Death

The same patient had an erect abdominal X-ray taken at initial presentation

Treatment

• Most cases of faecaloma are treated conservatively with laxatives and enemas
• Digital evacuation or catheter disimpaction may be required
• Endoscopic removal has also been described [Reference]
• In severe and unremitting cases – surgery is required to prevent significant complcations

In this case a trial of conservative measures failed, and surgical intervention was required....

Summary:

• Fecaloma should be considered in the differential diagnosis of any patient with history of chronic constipation and abdominal mass.
• Diagnosis is made form the clinical and radiologic features.
• Initial treatment is conservative. Rarely laparotomy is required to remove the mass.