What's the Diagnosis? By Sarab Sodhi

A 22 yo male with a history of Asperger syndrome and chronic constipation presents to the Emergency Department with abdominal pain and diarrhea for a week.  On exam he appears uncomfortable, he has tachycardia and a firm, distended, diffusely tender abdomen.  A cat scan is shown below.  What's the diagnosis?  (Scroll down for answer)






Answer: Sigmoid fecal impaction with massive dilation of sigmoid colon (20cm)

  • patient at high risk for perforation, taken to the operating room for sigmoidectomy, end-colostomy creation
  • the presentation of severe impaction is often similar to that of intestinal obstruction with pain, distension, vomiting and loss of appetite
  • risk factors include chronic constipation (metabolic, psychiatric, med-related) as well as functional and anatomic anorectal disorders
  • fecal impaction is most commonly seen at the extremes of age - the very young and the elderly
  • milder cases are managed with stool softeners, increased fiber and water intake, laxatives, enemas and manual disimpaction if stool is palpable in rectum
  • read more on fecal impaction