Dolichosigmoid with giant fecaloma as a cause of intestinal obstruction in a young patient

Abstract

Introduction: Fecaloma represents an extreme variant of fecal impaction, located primarily in the left colon due to fecal compaction and hardening. This clinical condition can manifest as intestinal obstruction, urinary retention, or toxic megacolon. On clinical examination, an abdominal palpable mass is generally detected. Initial treatment is usually conservative, including manual disimpaction, laxatives, and enemas. However, cases of giant fecalomas that do not respond to these measures pose a therapeutic challenge, often requiring surgical management. Case Report: A 23-year-old male with a history of chronic constipation presented with a 12-day history of absence of bowel movements, accompanied by progressive abdominal distension and vesical tenesmus. Physical examination revealed a distended abdomen with a palpable mass in the hypogastrium and right flank, while digital rectal exam evidenced impacted feces in the rectal ampulla. An abdominal and pelvic computed tomography scan showed the presence of a dolichosigmoid with a giant fecaloma, colonic dilation of 16 cm, and right hydronephrosis. After the failure of several cycles of proctoclysis, exploratory laparotomy was performed, allowing manual disimpaction of the fecaloma and a sigmoidectomy with the creation of a terminal colostomy in the descending colon and closure of the rectal stump. The surgery was completed without complications. Conclusion: The treatment of giant fecalomas associated with dolichosigmoid should initially be addressed with conservative measures. However, in refractory cases, surgical intervention becomes essential. This case highlights the importance of timely diagnosis and a personalized approach in patients with intestinal obstruction of benign etiology.