Sonographic appearance of fecal masses.

Abstract

Fecal impaction, caused by incomplete evacuation of feces over an extended length of time, may lead to the formation of a fecaloma, a large, firm mass of stool. Sonography is commonly used as the first imaging procedure in patients presenting with abdominal masses. In the five cases cited, fecaloma was suspected by sonography in four cases; confirmation was obtained by rectal examination in three cases and by radiographic studies in two cases. A representative case report is presented of a 74-year-old woman who had a large pelvic mass detected on physical examination. Sonographically, the fecaloma had a highly echogenic surface and a posterior acoustic shadow. Radiographic examination showed a "soap bubble" appearance, suggestive of stool. Thus, fecaloma should be considered in the differential diagnosis of patients with highly reflective and shadowing abdominal and/or pelvic masses.

Ultrasonographic Evidence of Ileus

“…Our data suggest that additional physical factors which aid in the recognition include the degree of bowel distention, the volume of the intraluminal air and or fluid [7,8] and the presence or absence of ascites.…”

“…Additionally, fecal masses involving the rectum and sigmoid occasionally have a highly echogenic surface and a posterior acoustic shadow, suggesting a large calcified uterine fibroid, on the ultrasound [7], On the other hand, some fluid-distended loops of bowel have to be distinguished from the ascitic fluid collection and large fluidfilled lesions such as mesenteric or duplica-tion cysts, ovarian cysts and cyst adenomas [2].…”

Gastrointestinal Ultrasound in Functional Disorders of the Gastrointestinal Tract - EFSUMB Consensus Statement

“…Constipation is one of the most common digestive problems affecting people of all ages. In chronic constipation due to fecal impaction, GIUS can detect hard stools within the colon as an intraluminal hypoechoic mass with posterior shadowing of varying diameter depending on the site and amount of fecal collection [54].…”

“…In children, the detection of hard stools in the rectum with an enlarged rectal diameter has been used as a predictor of constipation and fecal impaction. In particular, a rectopelvic ratio (the width of the rectum/the distance between the iliac spines) greater than 0.189 allowed the detection of megarectum with fecal impaction with a sensitivity of 88.3% 55 . In healthy adults, fecal retention of the rectum can also be detected by pocketsize US as a rectal area > 4.0 cm in diameter ( Fig.…”

Giant Fecaloma With Idiopathic Sigmoid Megacolon

“…9,10 Despite all these investigations, fecalomas have been confused with colonic malignancy. Most of the fecal impactions are successfully evacuated by conservative methods such as enemas, laxatives, and PEG and assisted at times by digital evacuation.…”