P4122 - Endoscopic Treatment of a Fecaloma Causing Large Bowl Obstruction in a 66-Year-Old Male

Ahmed Shukri, MD, Atul Ratra, MD, Jerapas Thongpiya, MD, Kanak Das, MD
Texas Tech University Health Sciences Center, Lubbock, TX

Introduction: Fecalomas are large retained indigestible fecal materials that form over time with constipation. Incidence is rare and reported in less than 1% of general population. Over decades, surgical intervention was the mainstay of treatment. However, with the development of new endoscopic modalities, non-surgical intervention became feasible with less surgical complications. We present a case of 66-year-old gentleman who presented with large bowl obstruction from a 4 cm bezoar and managed successfully with endoscopic decompression.

Case Description/Methods: A 66-year-old male without history abdominal surgeries, presented with acute diffuse colicky abdominal pain for 2 days, associated with constipation for 3 days. Physical exam was remarkable for diffuse abdominal tenderness without guarding or rebound tenderness. Digital rectal exam performed and revealed an empty rectum. Plain abdominal X-ray depicted dilated loops with evidence of fecal impaction. He underwent CT scan of the abdomen and depicted a calcified round mass consistent with bezoar measuring 4.2 x 4.0 x 4.4 cm within the mid descending colon. An upstream dilatation of the colon with a moderate amount of stool as well as air-fluid levels were present. Patient was assessed by general surgery team and recommended medical management. Gastroenterology team was consulted and performed a colonoscopy. A large multilamellated calcified stone was found in the distal descending colon. Removal was accomplished with an 18 mm extraction balloon, 20 mm CRE balloon, basket, rat-toothed forceps and multiple large caliber snares, tissue helix, and electrohydraulic lithotripsy technique. All these methods were able to fragment the stone to smaller pieces that were tiny enough for spontaneous passage per rectum and to relieve the obstruction. Patient tolerated the procedure well and was able to go home after 2 days.

Discussion: Fecalomas are the accumulation of feces in the intestine commonly with chronic constipation or intestinal motility disorders. Complications if left untreated are fatal and can lead to intestinal obstruction or perforation. Surgical or endoscopic management is considered if failed conservative management. With the upgoing enhanced endoscopic modalities, the success rate of endoscopic decompression has been increased. Therefore, a non-invasive endoscopic approach, if performed by a well-trained gastroenterologist, can carry a success decompression of large intestinal obstruction.



Disclosures:


Ahmed Shukri, MD, Atul Ratra, MD, Jerapas Thongpiya, MD, Kanak Das, MD. P4122 - Endoscopic Treatment of a Fecaloma Causing Large Bowl Obstruction in a 66-Year-Old Male, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.