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Annals of the Royal College of Surgeons... Mar 2022Acute appendicitis is common in patients with right lower quadrant pain and affects all gender and age groups. Because clinical diagnosis of patients with right lower...
Acute appendicitis is common in patients with right lower quadrant pain and affects all gender and age groups. Because clinical diagnosis of patients with right lower quadrant pain remains a challenge to emergency physicians and surgeons, imaging is of major importance. Ultrasound has well-established direct and indirect signs for diagnosing acute appendicitis and revealing the presence of an appendicolith. Appendectomy, which can be either open or laparoscopic, constitutes the basic treatment. However, the need for an appendectomy is debatable, particularly in high-risk patients. We report the case of a 42-year-old woman with no relevant medical history who was sent to the emergency department by her family physician with right lower quadrant pain of 18 hours' duration. Using ultrasound, the emergency physicians identified, inside the appendix, a 0.6cm appendiceal faecolith, migration of which was eventuated by manipulation of the ultrasound probe. The patient was then successfully treated non-operatively without any antibiotic prescription. Despite its rarity, migration of an appendiceal faecolith is possible. When migration of an appendicolith is perhaps actualised spontaneously or by ultrasound probe manipulation, the likelihood of an appendectomy decreases dramatically. This hypothesis provides patients who present an appendiceal faecolith with an alternative treatment approach that will lead to the avoidance of surgery, minimise morbidity and reduce hospitalisation costs.
Topics: Adult; Appendectomy; Appendicitis; Appendix; Fecal Impaction; Female; Humans; Ultrasonography
PubMed: 34812683
DOI: 10.1308/rcsann.2021.0122 -
Acute Medicine & Surgery 2022Gastric emphysema and emphysematous gastritis (EG) are rare diseases involving air being introduced into the stomach wall. Emphysematous gastritis is an infectious...
BACKGROUND
Gastric emphysema and emphysematous gastritis (EG) are rare diseases involving air being introduced into the stomach wall. Emphysematous gastritis is an infectious disease with a high fatality rate.
CASE PRESENTATION
An 83-year-old woman had recovered from septic shock, however, an antibiotic-refractory inflammatory response remained. She was diagnosed with pseudogout and administered a non-steroidal anti-inflammatory drug. However, abdominal pain, prominent abdominal distension, and strawberry milk-like gastric juice were recognized. Computed tomography showed ileus due to fecal impaction and GE. The results of culture of the gastric juice were positive ( and ). Disimpaction, fasting management, and antibacterial treatments resulted in the recovery of her symptoms.
CONCLUSION
This is the first case in which ileus associated with fecal impaction caused EG. The present case highlights the importance of promoting regular bowel movements.
PubMed: 35702418
DOI: 10.1002/ams2.759 -
GE Portuguese Journal of... Feb 2020
PubMed: 32266316
DOI: 10.1159/000501804 -
Advances in Medicine 2021Constipation is a condition that is very prevalent and is reported in up to 40 percent of individuals with intellectual and developmental disabilities (IDD).... (Review)
Review
Constipation is a condition that is very prevalent and is reported in up to 40 percent of individuals with intellectual and developmental disabilities (IDD). Constipation in this patient population is most commonly secondary to neuromuscular abnormalities, immobility, suboptimal diet, and medication side effects. History taking is frequently limited in adults with IDD due to communication barriers, often leading to a missed diagnosis of constipation. Inadequately treated constipation may lead to adverse effects including behavioral disturbances, fecal impaction, intestinal obstruction, and even death from intestinal perforation and sepsis. As a result, a high index of suspicion must exist for this patient population. Treatment in these patients requires an individualized approach, to reduce the constipation and its associated health complications.
PubMed: 34820456
DOI: 10.1155/2021/3248052 -
Medicine Aug 2022Gastrointestinal (GI) motility disorders represent a set of variable presentations caused by an abnormal functioning enteric neuromusculature. Any part of the GI tract...
RATIONALE
Gastrointestinal (GI) motility disorders represent a set of variable presentations caused by an abnormal functioning enteric neuromusculature. Any part of the GI tract can be affected, and depending on the organ involved, the patient presentation will differ.
PATIENT CONCERNS
A 26-years old female who had a history of laparoscopic Heller myotomy 15 years ago for progressive dysphagia. She presented with peritonitis and sigmoid colon perforation secondary to severe chronic constipation. Later after undergoing Hartman procedure, she continued to have significant constipation. In addition, she reported progressive dysphagia and regurgitation to both solids and liquids.
DIAGNOSIS
An esophageal manometry revealed Achalasia type 3, and stomach motility nuclear study showed mild delay in gastric emptying.
INTERVENTIONS
Initially, Hartmann procedure was performed. Afterward, we performed a reversal of Hartman, robotic redo of Heller myotomy, and Dor fundoplication was performed.
OUTCOMES
The patient had an uneventful postoperative course and was discharged in good condition.
LESSONS
Our case highlights an unusual presentation of GI motility disorder resulting in peritonitis from sigmoid colon perforation. Early recognition and prompt treatment of GI motility disorders are essential to avoid severe complications.
Topics: Adult; Colonic Diseases; Constipation; Deglutition Disorders; Esophageal Achalasia; Fecal Impaction; Female; Fundoplication; Humans; Intestinal Perforation; Laparoscopy; Peritonitis; Treatment Outcome
PubMed: 36042637
DOI: 10.1097/MD.0000000000030206 -
Neurogastroenterology and Motility Oct 2018Increasing age is associated with an increase in the incidence of chronic constipation and fecal impaction. The contribution of the natural aging process to these...
BACKGROUND
Increasing age is associated with an increase in the incidence of chronic constipation and fecal impaction. The contribution of the natural aging process to these conditions is not fully understood. This study examined the effects of increasing age on the function of the murine anorectum.
METHODS
The effects of increasing age on cholinergic, nitrergic, and purinergic signaling pathways in the murine anorectum were examined using classical organ bath assays to examine tissue function and electrochemical sensing to determine age-related changes in nitric oxide and acetylcholine release.
KEY RESULTS
Nitrergic relaxation increased between 3 and 6 months, peaked at 12 months and declined in the 18 and 24 months groups. These changes were in part explained by an age-related decrease in nitric oxide (NO) release. Cholinergic signaling was maintained with age by an increase in acetylcholine (ACh) release and a compensatory decrease in cholinesterase activity. Age-related changes in purinergic relaxation were qualitatively similar to nitrergic relaxation although the relaxations were much smaller. Increasing age did not alter the response of the anorectum smooth muscle to exogenously applied ACh, ATP, sodium nitroprusside or KCl. Similarly, there was no change in basal tension developed by the anorectum.
CONCLUSIONS AND INFERENCES
The decrease in nitrergic signaling with increasing age may contribute to the age-related fecal impaction and constipation previously described in this model by partially obstructing defecation.
Topics: Acetylcholine; Aging; Anal Canal; Animals; Male; Mice; Mice, Inbred C57BL; Motor Neurons; Muscle, Smooth; Nitric Oxide; Rectum; Signal Transduction
PubMed: 30062757
DOI: 10.1111/nmo.13426 -
PloS One 2014There are no existing studies that provide data regarding the epidemiology of, and risk factors for, fecal impaction, either in the general population or in any...
BACKGROUND
There are no existing studies that provide data regarding the epidemiology of, and risk factors for, fecal impaction, either in the general population or in any sub-group of people.
OBJECTIVE
Estimate the prevalence of and factors associated with fecal impaction on a representative sample of the institutionalized elderly population.
DESIGN
Two-phase study. Phase 1: pilot study validating the methodology in which all residents of a single nursing home participated. Phase 2: national multi-center cross-sectional study.
SETTING
34 randomly selected nursing homes.
MEASUREMENTS
The presence of fecal impaction and associated factors were evaluated using three different tools: data collected from medical records; a self-completion questionnaire filled out by the subjects or a proxy; and a rectal examination.
SUBJECTS
Older subjects living in nursing homes.
RESULTS
The prevalence of chronic constipation was 70.7% (95%CI: 67.3-74.1%), of which 95.9% of patients were properly diagnosed and 43.1% were properly controlled. The prevalence of FI according to patient history was 47.3% (43.6-51.0%) and 6.6% (4.7-8.5%) according to rectal examination. Controlled constipation (OR: 9.8 [5.2-18.4]) and uncontrolled constipation (OR: 37.21 [19.7-70.1]), the number of medications (OR: 1.2 [1.1-1.3]), reduced functional capacity (OR: 0.98 [0.97-0.99]) and the occasional use of NSAIDs were independent risk factors for fecal impaction.
CONCLUSIONS
Constipation affects more than 70% of people living in nursing homes. Although it is properly diagnosed in more than 95% of cases, the disease is only controlled in less than 50%. Constipation, especially when not controlled, is the most significant risk factor leading to fecal impaction, which is prevalent in almost 50% of this population.
Topics: Aged; Aged, 80 and over; Comorbidity; Constipation; Cross-Sectional Studies; Fecal Impaction; Female; Humans; Laxatives; Male; Nursing Homes; Pilot Projects; Prevalence; Risk Factors; Spain; Surveys and Questionnaires
PubMed: 25148393
DOI: 10.1371/journal.pone.0105281 -
Rhode Island Medical Journal (2013) Dec 2021Chronic constipation and fecal impaction are common in older individuals but can also be found in younger patients with cognitive and psychiatric illnesses. The...
Chronic constipation and fecal impaction are common in older individuals but can also be found in younger patients with cognitive and psychiatric illnesses. The diagnosis of fecal impaction and, the assessment of severity are best performed clinically. Here, we present a case of a 30-year-old autistic individual where limited history was obtainable and further imaging helped to urgently diagnose a 47 x 15.6 x 12 cm stool ball, causing significant mass effect of surrounding intra-abdominal structures. Fecal disimpaction and aggressive bowel regimen prevented the pathological effects of severe fecal retention.
Topics: Adult; Aged; Constipation; Fecal Impaction; Humans
PubMed: 34846372
DOI: No ID Found -
Clinical Practice and Cases in... Mar 2017Fecal impactions are a common complaint in the emergency department (ED) population. The potential for significant derangement in physiologic processes of other organ...
Fecal impactions are a common complaint in the emergency department (ED) population. The potential for significant derangement in physiologic processes of other organ systems is often underappreciated. A 19-year-old male, previously healthy, presented to the ED at our institution with complaint of abdominal pain, which was found to be secondary to severe fecal impaction. In the search for alternative diagnoses, imaging was performed, which revealed effects on multiple other organ systems. This case illustrates the secondary effects of a severe fecal impaction. The emergency physician must be aware of these consequences, as the opportunity to review labs and imaging is not often provided in the standard workup of these patients.
PubMed: 29849401
DOI: 10.5811/cpcem.2016.12.32754 -
Yonago Acta Medica Feb 2021Fecal impaction is the impaired excretion of a large fecal mass, and mild cases are treated by enema and osmotic laxatives. However, treatment-resistant cases need more...
Fecal impaction is the impaired excretion of a large fecal mass, and mild cases are treated by enema and osmotic laxatives. However, treatment-resistant cases need more invasive alternatives. A woman in her 60s presented with abdominal discomfort. Her abdomen was soft and without tenderness. Computed tomography revealed a large mass of feces in her sigmoid colon and no intestinal dilatation proximal to the mass. Endoscopy confirmed a fecal mass occupying the lumen. A glycerin enema, oral administration of polyethylene glycol, and enteral administration of amidotrizoic acid during colonoscopy were ineffective. We maneuvered a guidewire to form a loop at the tip of an endoscope, with which we subdivided the mass for successful removal. The patient's abdominal discomfort disappeared immediately. Endoscopic disimpaction is far less invasive than surgery and should be considered when treating fecal impaction cases, without severe obstructive colitis, which are nonresponsive to conservative treatment.
PubMed: 33642913
DOI: 10.33160/yam.2021.02.015