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Death by fecaloma

Abstract

A 59-year-old man with a history of cerebral palsy and dextroscoliosis died in a group home. He required supplemental oxygen and had no bowel movement for weeks prior to death. At autopsy, the abdomen was markedly distended and there were flexion contractures of the legs. Postmortem computed tomography revealed a dilated digestive tract and fecal loading in the sigmoid and rectum, marked upwardly displaced diaphragm and scoliosis. On internal examination, the diaphragm was displaced rostrally and the rectosigmoid colon contained 2.5 kg of fecaloma with two rectal fecaliths. Severe scoliosis with marked reduction in volume of thoracic cavity was present. Microscopic examination revealed chronic aspiration pneumonia and chronic pulmonary hypertension. Overall, four factors led to respiratory failure: fecaloma; cerebral palsy; scoliosis; and chronic aspiration pneumonia. Based on clinicopathological correlation, the cause of death was determined to be a combination of these factors, and the key acute factor was the fecaloma.

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References

  1. Roussos C, Koutsoukou A. Respiratory failure. Eur Respir J. 2003;22(Suppl. 47):3s–14s.

    Article  Google Scholar 

  2. Jan MM. Cerebral palsy: comprehensive review and update. Ann Saudi Med. 2006;26:123–32.

    Article  Google Scholar 

  3. Amankwah N, Oskoui M, Garner R, Bancej C, Manuel DG, Wall R, et al. Cerebral palsy in Canada, 2011–2031: results of a microsimulation modelling study of epidemiological and cost impacts. Health Promot Chronic Dis Prev Can. 2020;40:25–37.

    Article  Google Scholar 

  4. Shi J, Al-Shamli N, Chiang J, Amin R. Management of rare causes of pediatric chronic respiratory failure. Sleep Med Clin. 2020;15:511–26.

    CAS  Article  Google Scholar 

  5. Koumbourlis AC. Scoliosis and the respiratory system. Paediatr Respir Rev. 2006;7:152–60.

    Article  Google Scholar 

  6. Aiyappan SK, Ranga U, Samraj A, Rajan SC, Veeraiyan S. A case of fecaloma. Indian J Surg. 2013;75:323–4.

    Article  Google Scholar 

  7. Garisto JD, Campillo L, Edwards E, Harbour M, Ermocilla R. Giant fecaloma in a 12-year-old-boy: a case report. Cases J. 2009;2:127.

    Article  Google Scholar 

  8. Zurabishvili K, Rekhviashvili A, Sakhamberidze M, Tsiklauri K. A case of giant fecaloma in a 24-year-old woman. Georgian Med News. 2015;240:11–4.

    Google Scholar 

  9. García Contreras AA, Vásquez Garibay EM, Sánchez Ramírez CA, Fafutis Morris M, Delgado RV. Factors associated with the stool characteristics of children with cerebral palsy and chronic constipation. Rev Esp Enferm Dig. 2020;112:41–6.

    PubMed  Google Scholar 

  10. Marciniak CM, Lee J, Jesselson M, Gaebler-Spira D. Cross-sectional study of bowel symptoms in adults with cerebral palsy: Prevalence and impact on quality of life. Arch Phys Med Rehabil. 2015;96:2176–83.

    Article  Google Scholar 

  11. Waseem M, Hipp A. Megacolon: constipation or volvulus? Pediatr Emerg Care. 2006;22:346–8.

    Article  Google Scholar 

  12. Gorecki PJ, Kessler E, Schein M. Abdominal compartment syndrome from intractable constipation. J Am Coll Surg. 2000;190:371.

    CAS  Article  Google Scholar 

  13. Flageole H, Ouahed J, Walton JM, Yousef Y. Abdominal compartment syndrome secondary to chronic constipation. Case Rep Pediatr. 2011;2011:562730.

  14. Zarog MA, O'Leary DP, Levins KJ, Byrnes GJ. Abdominal compartment syndrome secondary to megarectum and megasigmoid. BMJ Case Rep. 2018;2018:bcr2017224097.

  15. Starnes DS, Lawrence H, Navaratnam R. Is constipation a trivial matter? BMJ Case Rep. 2016;2016:bcr2015213085.

  16. Milanese A, Schechter NL, Ganeshananthan M. Constipation presenting as respiratory distress. J Adolesc Health Care. 1986;7:255–8.

    CAS  Article  Google Scholar 

  17. Logre E, Degravi L, Plantefève G, Contou D. A fatal fecaloma. Int J Emerg Med. 2020;13:46.

    Article  Google Scholar 

  18. Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry. 2018;17:341–56.

    Article  Google Scholar 

  19. Suttajit S, Srisurapanont M, Maneeton N, Maneeton B. Quetiapine for acute bipolar depression: a systematic review and meta-analysis. Drug Des Devel Ther. 2014;8:827–38.

    Article  Google Scholar 

  20. Jahromi SR, Togha M, Fesharaki SH, Najafi M, Moghadam NB, Kheradmand JA, et al. Gastrointestinal adverse effects of antiepileptic drugs in intractable epileptic patients. Seizure. 2011;20:343–6.

    Article  Google Scholar 

  21. Byard RW, Couper RTL, Cohle S. Gastric distension, cerebral palsy and unexpected death. J Clin Forensic Med. 2001;8:81–5.

    CAS  Article  Google Scholar 

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Acknowledgements

The authors thank Dr. Toby Rose and Ms. Effie Waldie (Ontario Forensic Pathology Service) for assisting with manuscript preparation.

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Correspondence to Yosuke Usumoto.

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Usumoto, Y., Pollanen, M.S. Death by fecaloma. Forensic Sci Med Pathol 18, 201–204 (2022). https://doi.org/10.1007/s12024-021-00438-1

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  • DOI: https://doi.org/10.1007/s12024-021-00438-1

Keywords

  • Fecaloma
  • Fecalith
  • Cerebral palsy
  • Scoliosis
  • Chronic aspiration pneumonia
  • Respiratory failure