Cecal Fecaloma Due to Intestinal Tuberculosis: Endoscopic Treatment

Abstract

Colorectal fecaloma is a mass of accumulated feces that is much harder in consistency than a fecal impactation. The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site. Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, endoscopic procedures or a surgical intervention may be needed. We report here that a cecal fecaloma caused by intestinal tuberculosis scar was successfully removed by endoscopic procedures.

Fecaloma Resulting in Bowel Obstruction and Death: Case Report and Review of Literature

“…It results from accumulation of fecal material that forms a mass separate from other bowel contents [5,6]. It has been described in patients with Hirschsprung's disease, idiopathic chronic constipation and psychiatric patients [1,7]. Our Case has several teaching points and highlights the importance of early detection of these patients which could potentially result in a favorable outcome.…”

Chronic Abdominal Pain: A Case of Giant Fecalith in the Distal Jejunum

“…Conservative treatment may be attempted, but if it fails, the patient should undergo a surgical approach. Laparoscopies have been successfully attempted and if it fails, or if patient is not a suitable candidate for laparoscopy, then open laparotomy should be considered [8][9].…”

Successful endoscopic fragmentation of large hardened fecaloma using jumbo forceps

“…Fecalomas commonly develop in the sigmoid colon and the rectum, which have a narrower lumen than that of the right colon[ 2 ]. Underlying diseases reported to result in fecalomas include chronic fecal impaction, Hirschsprung's disease, psychiatric disorders, and intestinal tuberculosis[ 3 , 4 ]. Generally, fecalomas cause intestinal obstruction, megacolon, and gastrointestinal perforation, and can even result in deep vein thrombosis and urinary tract compression on rare occassions[ 5 - 7 ].…”

“…However, there are few reports describing endoscopic extraction of a large fecaloma. In previous reports, endoscopic extraction was successfully performed using conventional forceps and a snare for polypectomy[ 2 , 4 ]. In our patient, however, the fecaloma could not be fragmented with forceps or a snare, presumably due to its hardness and the slipperiness of its surface.…”