Abstract
An 80-year-old man with constipation and abdominal bloating was transported by ambulance to hospital. Examination showed slight abdominal distension, but no signs of peritoneal irritation. Abdominal CT showed fecal impaction from the sigmoid colon to the rectum, dilatation of the proximal colon, and fluid accumulation. Blood tests showed an elevated inflammatory response, dehydration, and metabolic acidosis with respiratory compensation. Because of worsening lower abdominal pain, respiratory distress, and obtundation, bowel necrosis and perforation were suspected, and emergency surgery was performed.
On laparotomy, brownish fluid that smelled like feces was found in the abdominal cavity. There was intestinal thinning of the ileum and colon, and in particular, the lower intestinal mucosa was darkened, and the thinned intestine appeared necrotic. A total colectomy was performed, and an ileostomy was created. Postoperatively, the patient required defibrillation for atrial flutter, but later, treatment with an endotoxin absorption column was successful.
Intestinal obstruction due to fecal impaction is fairly common in diabetic and dialysis patients, but cases requiring surgery are relatively rare. This case is reported along with a discussion of the relevant literature.
