From Fecal Impaction to Colon Perforation

Craft, Leah; Prahlow, Joseph A.

doi:10.1097/01.naj.0000403360.82176.76

Cited by 15 publications

(10 citation statements)

References 25 publications

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“…Thus, invasive procedures requiring understanding and consent should be avoided as much as possible. Moreover these patients can have a high incidence of fecal impaction and fecal stones, which may cause stercoral ulcers and perforation 16. Perforation, if this occurs, is on a background of a colon full of fecal material and carries a very high risk of peritoneal spilling and peritonitis.…”

Section: Discussionmentioning

confidence: 99%

Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable

Niv¹,

Grinberg²,

Dickman³

et al. 2013

IJGM

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ObjectivesConstipation is a common complaint, frequently treated with cleansing enema. Enemas can be very effective but may cause serious adverse events, such as perforation or metabolic derangement. Our aim was to evaluate the outcome of the use of cleansing enema for acute constipation and to assess adverse events within 30 days of therapy.MethodsWe performed a two-phase study: an initial retrospective and descriptive study in 2010, followed by a prospective study after intervention, in 2011. According to the results of the first phase we established guidelines for the treatment of constipation in the Emergency Department and then used these in the second phase.ResultsThere were 269 and 286 cases of severe constipation in the first and second periods of the study, respectively. In the first study period, only Fleet® Enema was used, and in the second, this was changed to Easy Go enema (free of sodium phosphate). There was a 19.2% decrease in the total use of enema, in the second period of the study (P < 0.0001). Adverse events and especially, the perforation rate and the 30-day mortality in patients with constipation decreased significantly in the second phase: 3 (1.4%) versus 0 (P = 0.0001) and 8 (3.9%) versus 2 (0.7%) (P = 0.0001), for perforation and death in the first and second period of the study, respectively.ConclusionEnema for the treatment of acute constipation is not without adverse events, especially in the elderly, and should be applied carefully. Perforation, hyperphosphatemia (after Fleet Enema), and sepsis may cause death in up to 4% of cases. Guidelines for the treatment of acute constipation and for enema administration are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable

Niv¹,

Grinberg²,

Dickman³

et al. 2013

IJGM

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“…This type of lesion most often occurs in the sigmoid and rectosigmoid colon, due to the harder consistency of the faeces, smaller diameter of the colon and poorer vascularisation especially on the anti-mesenteric border [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Fecal impaction: a systematic review of its medical complications

et al. 2016

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BackgroundFecal impaction (FI) is a common problem in the elderly and other at-risk groups, such as patients with a neuro-psychiatric disease. It has been associated with medical problems and high morbi-mortality. A systematic review of this topic might be useful to improve the knowledge in this area and helpful to make an appropriate and early diagnosis.MethodsA PubMed systematic search was performed using relevant keywords. Case reports published in English, Spanish or French till June 2014 were included if they had a diagnosis of FI and a medical complication secondary to it. Each case was classified based on its principal complication. The main objective is to create a classification of FI complications based on published clinical cases.Results188 articles met inclusion criteria, comprising 280 clinical cases. Out of the total, 43,5 % were over 65 years old, 49 % suffered from chronic constipation, 29 % had an underlying neuropsychiatric disease and 15 % were hospitalised or institutionalised. A total of 346 medical complications secondary to FI were collected. They were divided according to gastrointestinal tract involvement and then classified based on their anatomical and pathophysiological mechanism into three groups: Complications secondary to fecaloma effect on the intestinal wall (73.4 %), on the intestinal lumen (14 %) and on adjacent structures (12.6 %).ConclusionsFI causes complications that might be fatal. The elderly, underlying neuropsychiatric disease and hospitalised or institutionalised patients integrate the high-risk group in which FI must be suspected. The first FI complications classification is presented to improve the knowledge about this entity.

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“…In severe cases, impaction may result in stercoral ulcers of the colon, causing acute or chronic abdominal pain, gastrointestinal bleeding, or perforation with peritonitis . There are case reports of death …”

Section: Discussionmentioning

confidence: 99%

High‐Grade Rectal Impaction by Feces and Oral Contrast: Case Report and Images

Stall

Grover

2014

J American Geriatrics Society

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with fever, hypotension, and lethargy. She was diagnosed with urinary tract infection and treated with piperacillin and tazobactam. While in the hospital, she was started on MA 400 mg/d for anorexia and weight loss. After improvement with antibiotics and hydration, she was discharged back to the nursing home, where she was noted to be alert with a blood pressure of 121/80 mmHg but appeared generally weak with a voice just above an audible whisper.One month after MA was started, her systolic blood pressure had gradually decreased to the 80s, and she remained alert, but her generalized weakness and anorexia had worsened, and she became bedbound, being unable to stand or walk without assistance. Her blood chemistry was significant for sodium of 133 mmol/L (normal range 135-142 mmol/L) but was otherwise unremarkable, including thyroid function test. Morning cortisol (3.1 lg/dL, normal range 6.0-22.4 lg/dL) and adrenocorticotropic hormone (ACTH) were low (<5 pg/mL, normal range 5-27 pg/mL). MA-related AI was suspected. Dexamethasone 0.5 mg twice a day was started for clinical response because dexamethasone would not affect cosyntropin stimulation test. MA was tapered and discontinued. Cosyntropin stimulation test revealed a blunted adrenal response to intramuscular cosyntropin 250 lg with cortisol levels of 2.8 lg/dL at 0 minutes, 7.7 lg/dL at 30 minutes, and 13.1 lg/dL at 60 minutes. Brain magnetic resonance imaging did not show tumor.She made remarkable improvements. Her appetite significantly improved, her blood pressure normalized, and her soft voice resolved. Her general weakness also improved to the point where she could ambulate short distances with a walker. More importantly, she regained a great measure of her quality of life, to the point that she was able to go on outings with her family.This case illustrates the importance of keeping AI in the differential diagnosis in cases in which an elderly adult presents with a constellation of symptoms of which each symptom individually, such as generalized weakness, can suggest a myriad of differential diagnoses. In addition, in cases in which an individual is taking MA, the risk of AI should be kept in mind. With a wider recognition of the side effects of MA and awareness that it is on the Beers criteria for potentially inappropriate medications for older adults, MA should be used judiciously, weighing the risks and benefits. 2 MA is a synthetic progestational agent that has been used for breast and endometrial cancer and as an appetite stimulant for anorexia and cachexia. 3 AI can be categorized into primary and secondary AI. 4 In this case, AI was secondary, caused by MA-induced suppression of ACTH secretion, which in turn caused decreased cortisol production. MA is known to have glucocorticoid-like activity, which can suppress the hypothalamic-pituitaryadrenal axis. 5 Doses as low as 160 mg/d can suppress ACTH secretion. 6 Uncorrected or untreated, AI can lead to death. The presentation of AI can be nonspecific, increasing the risk of delayed diagnosis or misdia...

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From Fecal Impaction to Colon Perforation

Cited by 15 publications

References 25 publications

Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable

Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable

Fecal impaction: a systematic review of its medical complications

High‐Grade Rectal Impaction by Feces and Oral Contrast: Case Report and Images

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