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Fecal Impaction

  • Large Intestine (B Cash, Section Editor)
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Abstract

Fecal impaction (FI) is a common and potentially serious medical condition that occurs in all age groups. Children, incapacitated patients, and the institutionalized elderly are considered the highest at-risk populations. FI usually occurs in the setting of chronic or severe constipation, anatomic anorectal abnormalities, and neurogenic or functional gastrointestinal disorders. Generally, FI is a preventable disorder, and early recognition is important, as it is associated with increased morbidity, mortality, and high health care costs. Evaluation with a careful history and physical examination, in conjunction with radiologic imaging, such as an acute abdominal series or computed tomography (CT), is imperative. Prompt identification and treatment minimize the risk of complications attributable to FI, which may include bowel obstruction leading to stercoral ulcer, perforation, peritonitis, or cardiopulmonary collapse with hemodynamic instability. Treatment options include manual fragmentation and extraction of the fecal mass, distal colonic cleansing using enemas and rectal lavage with the aid of a sigmoidoscope, and/or using water-soluble contrast media such as Gastrografin to both identify the extent of the impaction and aid in cleansing and removal. Surgical resection of the involved colon or rectum is reserved for peritonitis resulting from bowel perforation. Since recurrence is common, implementing preventive measures such as increasing daily water and fiber intake, limiting medications that decrease colonic motility, using secretagogues or prokinetic agents, and treating underlying anatomic defects are highly important.

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Conflict of Interest

Zilla H. Hussain, Brian E. Lacy, and Diana A. Whitehead declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Area 4C 1 Medical Center Drive, Lebanon, NH, 03756, USA

    Zilla H. Hussain, Diana A. Whitehead & Brian E. Lacy

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  1. Zilla H. Hussain
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  2. Diana A. Whitehead
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  3. Brian E. Lacy
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Correspondence to Zilla H. Hussain.

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This article is part of the Topical Collection on Large Intestine

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Hussain, Z.H., Whitehead, D.A. & Lacy, B.E. Fecal Impaction. Curr Gastroenterol Rep 16, 404 (2014). https://doi.org/10.1007/s11894-014-0404-2

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  • DOI: https://doi.org/10.1007/s11894-014-0404-2

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