A Case of a Giant Enterolith Formed at a Functional End-to-end Anastomosis Requiring Surgical Removal

Tateno, Yuki; Imamura, Masayuki; Hayashi, Tetsuo; Hataji, Kenichiro; Tezuka, Tohru; Katsuragawa, Hideo

doi:10.3919/jjsa.81.2285

Cited by 1 publication

(4 citation statements)

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“…As mechanisms of a fecaloma develop at FEEA, we speculate that the colon at the site of an FEEA tends to become extremely large compared to the proximal and distal colonic diameters, creating a kind of diverticulum, which can cause the stasis of feces, resulting in a fecaloma. Toyosaki et al [7] and Tateno et al [9] advocated the same mechanisms. In the present patient, some dilatation was actually observed at the anastomosis as shown in Fig.…”

Section: Discussion/conclusionmentioning

confidence: 94%

“…Surgery with colonic resection was performed in 4 patients [5][6][7]9], while nonoperative therapy with colonoscopic fragmentation was carried out in 3 [4,8] (Table 2). Among the 4 patients who underwent surgery, Kawaguchi et al [5] and Toyosaki et al [7] performed a colonic resection without any preceding treatment.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Among the 4 patients who underwent surgery, Kawaguchi et al [5] and Toyosaki et al [7] performed a colonic resection without any preceding treatment. Tateno et al [9] unsuccessfully used colonoscopic fragmentation of the fecaloma before the surgery. Sato et al [6] also tried colonoscopic fragmentation and then treated the fecal mass causing colonic obstruction with oral entero-lavage.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…To the best of our knowledge, 6 patients with fecaloma have been reported, which developed at the anastomotic site after colorectal surgery [4][5][6][7][8][9] (Table 2). The English language literature was searched with the key words ("fecaloma" or "fecalith" or "fecal impaction" or "blind loop syndrome" or "blind pouch syndrome" or "stercoral") and ("surgery" or "anastomosis" or "colonic surgery" or "functional end to end" or "side-to-side" or "side-toend" or "hand sewn" or "double stapling" or "DST") on PubMed for papers between January 2001 and February 2021.…”

Section: Discussion/conclusionmentioning

confidence: 99%

See 3 more Smart Citations

Colonoscopic Treatment of a Fecaloma at the Anastomotic Site after Colectomy

Homma¹,

Mimura²,

Sadatomo³

et al. 2021

Case Rep Gastroenterol

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Fecalomas most commonly occur in constipated patients and are rarely reported after colectomy. A 55-year-old Japanese female presented with a fecaloma after colectomy, which was impacted at a functional end-to-end anastomosis (FEEA) site. Four and a half years ago, she underwent sigmoidectomy for colon cancer. A follow-up computed tomography (CT) scan revealed an 11 cm incidental fecaloma. The patient was advised to undergo surgery, but she desired nonoperative management because of minimal symptoms, and was referred to our institution. On the day of admission (day 1), mechanical fragmentation of the fecaloma was attempted during the first colonoscopy. Although a large block of stool was evacuated after a second colonoscopic fragmentation on day 8, the third colonoscopy on day 21 and CT scan on day 22 showed no significant change in the fecaloma. Frequent colonoscopic fragmentation was performed, with a fourth, fifth, and sixth colonoscopy on days 24, 29, and 31, respectively. After the size reduction was confirmed at the sixth colonoscopy, the patient was discharged home on day 34. The fecaloma completely resolved after the seventh colonoscopic fragmentation on day 44. Sixteen months after treatment, there is no evidence of recurrent fecaloma. According to the literature, risk factors for fecaloma after colectomy include female gender, left-side colonic anastomosis, and FEEA. FEEA might not be recommended for anastomoses in the left colon, particularly in female patients, to avoid this complication. Colonoscopic fragmentation is recommended for fecalomas at an anastomotic site after colectomy in patients without an absolute indication for surgery.

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Section: Discussion/conclusionmentioning

confidence: 94%