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• W2979290287 abstract "Introduction: Fecalith, an impacted mass of feces, is commonly implicated with mechanical obstruction of the large bowel. Usually in the setting of predisposing conditions (i.e. diabetic neuropathy, large diverticula in the small bowel, and underlying inflammatory conditions). This case details an individual with small bowel obstruction (SBO) in the terminal ileum secondary to a fecalith with no identifiable predisposing factors. Presentation: A 76-year-old female presented to our hospital with a 3-week history of crampy, intermittent abdominal pain, worse after eating and constipation and inability to pas flatus the day of admission. She had a history of irritable bowel syndrome, stage III chronic kidney disease. On examination, abdomen was soft, tender to palpation in the mid-epigastric and umbilical region, mildly distended with hypoactive bowel sounds. Her stools were guaiac negative with no palpable mass on rectal examination. Diagnostic evaluation admission laboratory data showed leukocytosis with a white cell count of 16,000. Rest of labs including amylase, lipase, lactate, renal, liver function tests were. A magnetic resonance angiogram without contrast was performed to further evaluate the mesenteric vasculature which showed a small bowel loop dilation measuring 3.8 cm with collapsed colon and terminal ileum suggestive of a high-grade small bowel obstruction with the transition zone in the distal ileum. A nasogastric tube was placed for gastric decompression. In spite of conservative management for 8 days, she failed to improve and her abdomen got distended to the extent of causing respiratory distress. She was taken to the operating room for surgical intervention. Exploratory laparotomy showed a fixated, firm intraluminal mass at the proximal ileum, with no other mesenteric masses or strictures noted. A segmental small bowel resection was performed and 17 cm of bowel was taken out and dissected, revealing a yellow inspissated ball of stool measuring approximately 3 cm in diameter. The specimen was sent to pathology, which confirmed the mass as a fecalith. Discussion: Fecalith is an impacted mass of feces and known to cause mechanical obstruction of the large bowel. Optimal therapeutic approach for an individual with small bowel obstruction secondary to a fecalith does not differ from other causes of small bowel obstruction. Conservative measures should initially supersede surgical intervention, such as nasogastric tube with decompression and IV hydration. As our case report shows, fecaliths should also be considered as a part of the differential diagnosis of SBO." @default.
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• W2979290287 date "2013-10-01" @default.
• W2979290287 modified "2023-10-14" @default.
• W2979290287 title "Small Bowel Obstruction due to Fecalith in the Terminal Ileum" @default.
• W2979290287 doi "https://doi.org/10.14309/00000434-201310001-00961" @default.
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