Fecal Impaction Causing Pelvic Venous Compression and Edema

Abstract

Chronic constipation is a common condition which may result in fecal impaction. A 13-year-old male with chronic constipation and encopresis presented with fecal impaction for three weeks. The impaction caused abdominal pain, distension, encopresis, and decreased oral intake. He was found in severe distress with non-pitting edema of his feet and ankles along with perineal edema. The pedal edema worsened after receiving a fluid bolus, so concern arose for venous compression or a thrombus. A Duplex Ultrasound demonstrated changes in the venous waveforms of the bilateral external iliac and common femoral veins without thrombosis. Manual disimpaction and polyethylene glycol 3350 with electrolytes resolved the pedal and perineal edema. Four months later, he had soft bowel movements without recurrence of the edema. A repeat Duplex Ultrasound was normal. We present a child in whom severe fecal impaction caused pelvic venous compression resulting in bilateral pedal and perineal edema.

Faecal impaction causing bilateral pelvic venous thrombosis

“…This last group mainly comprises compression of the urinary tract, responsible for 8.5% of the reported complications; whereas effects of FI on adjacent vascular or nervous structures were rather anecdotical (1.26%). Only a handful papers report pelvic venous compression due to a rectal faecaloma [3][4][5][6]. Because of anatomical considerations, the left iliac vein seems the most vulnerable to compression [3,4].…”

“…Because of anatomical considerations, the left iliac vein seems the most vulnerable to compression [3,4]. A recent communication by Naramore et al (2015) reported a bilateral compression of the pelvic veins secondary to FI in a paediatric patient [5]. Two reports even illustrated compression of the inferior cava vein secondary to a giant intra-abdominal faecal mass [4,6].…”