Analyzing fecal loading and retention patterns by abdominal X-rays of hospitalized older adults: A retrospective study.

Background: Aging may affect ascending colon (AC) differently from descending colon (DC) and increase the risk of fecal loading (FL) in AC. Methods: Patients aged ≥65 years admitted to a community hospital were analyzed by abdominal x-ray for fecal loads and stool retention patterns. FL was scored between 0 and 5 (severe) on each segment of colon with a possible total score 20. Mean segment scores ≥3.5 were designated as high scores for both AC and DC. Logistic regression was performed between groups to identify factors associated with FL patterns. Results: Groups identified were high FL in both AC and DC (N = 21, 17.2%), FL predominantly in AC (N = 38, 31.1%), low FL in both AC and DC (N=60, 49.2%), and FL low in AC and high in DC (N = 3, 2.5%). Among 71 patients with total FL scores ≥13 (indicating significant stool retention), 37 (52.1%) had the FL predominantly in AC. Patients prescribed antibiotic(s) prior to hospitalization had lower odds of FL predominantly in AC (adjusted odds ratio = 0.18, 95% confidence interval = 0.04-0.84) compared to the group of low FL in both AC and DC with the adjustment of confounders. Conclusion: This study found that 52.1% of those with significant stool retention on x-ray had the FL predominantly in AC. Antibiotic use was associated with lower odds of having FL predominately in AC. This study provided insights of FL distribution in colon and AC could be an area for significant stool burden in older adults with stool retention.

Fecal Loading at Caecum as a New Radiological Sign for Diagnosing Acute Appendicitis.

Background The present study aimed to address the importance of a new radiological sign - the presence of fecal loading at the caecum - for the diagnosis of acute appendicitis. Methodology A cross-sectional study was conducted at the Department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi from January 2020 to June 2020. Patients who presented in the emergency with acute pain at the right iliac fossa fulfilling the criteria of acute appendicitis (AA) according to the Alvarado scoring system, and were planned for appendectomy were included. Before surgery plain abdominal radiographs were taken in anteroposterior view in the supine position and were evaluated for the presence of fecal loading at the caecum. After that all patients underwent surgery and radiologic findings were correlated with histopathologic findings. Results The mean age of patients was 32.19±7.34 years. There were 83 (55.3%) male and 67 (44.7%) female patients. Out of 150, there were 144 (96.0%) patients in whom fecal loading in the caecum was diagnosed on plain radiographs. On histopathology reporting, acute appendicitis was diagnosed in 143 (95.3%) patients. Regarding accuracy, fecal loading at the caecum was found to have a sensitivity of 98.6%, specificity of 83.3%, a positive predictive value of 99.3%, and a negative predictive value of 71.4%.  Conclusion According to the results of the present study and existing literature, we suggest using fecal loading at the caecum along with a clinical scoring system for the diagnosis of acute appendicitis. As per our findings, fecal loading at the caecum is a valuable sign on plain abdominal radiograph for the diagnosis of AA. It has a sensitivity of 98.6% and a specificity of 83.3%. This sign typically becomes undetectable after an appendectomy. It will help to improve the accuracy of diagnosis of acute appendicitis, and hence will reduce the chances of negative appendectomy.

Use of X-ray to Assess Fecal Loading in Patients with Gastrointestinal Symptoms.

BACKGROUND/AIMS: There is currently no gold standard for evaluating stool burden in the colon for patients with gastrointestinal symptoms. We aim to examine the relationship between fecal loading on single view abdominal X-ray imaging and gastrointestinal symptoms such as constipation, diarrhea, bloating, and accidental bowel leakage in adult outpatients. METHODS: This retrospective, cross-sectional study examined patients seen at University of Michigan from 2005 to 2017. Chart review of demographic information, reported gastrointestinal symptoms, past medical history, and abdominal radiographic imaging was performed. Bivariate analysis was performed to assess associations between these characteristics and fecal loading. Factors independently associated with fecal loading were identified using logistic regression. Significance was established at p < 0.05. RESULTS: In total, 319 patients who had an X-ray were included in the final analysis, with 84.0% demonstrating fecal loading on the initial X-ray and most reporting constipation as a symptom (n = 214, 84.3%, p = 0.0334). In logistic regression, a chief complaint of constipation had higher odds of being associated with fecal loading on X-ray compared to diarrhea (adjusted OR 6.41; CI 1.51-27.24, p = 0.0118). Bloating as a reported symptom was statistically significant with an adjusted OR of 2.56 (CI 1.10-5.96, p = 0.0286). CONCLUSIONS: Constipation (as a chief complaint) and bloating (as a symptom) were associated with fecal loading on X-ray imaging, while accidental bowel leakage and diarrhea were not.

Radiographic stool quantification: an equivalence study of 484 symptomatic and asymptomatic subjects.

PURPOSE: To determine if symptomatic patients referred for radiographic stool quantification have equivalent stool burden to asymptomatic patients. METHOD: This was an IRB-approved HIPAA-compliant retrospective equivalence cohort study. An a priori equivalence power calculation was performed. Consecutive abdominal radiographs performed in adult outpatients with bloating, constipation, diarrhea, or abdominal pain to assess "fecal loading" [n = 242 (fecal cohort)] were compared to those performed in asymptomatic adult outpatients to assess "renal stones" [n = 242 (renal cohort)]. Radiographs were randomized and reviewed by two blinded independent abdominal radiologists. Exclusion criteria, designed to avoid unblinding, included urinary tract calculi ≥ 0.5 cm, multiple urinary tract calculi, and ureteral stent(s). Readers scored all radiographs (n = 484) for stool burden using validated Leech criteria [scale: 0 (none) to 15 (extreme diffuse)]. Mean Leech scores and 95% confidence intervals were calculated. Multivariable generalized linear modeling was performed to adjust for baseline medication use, age, and gender. The adjusted parameter estimate was used to test for equivalence in the mean difference between cohorts using Schuirmann's method of two one-sided t-tests. Inter-reader agreement was assessed with intraclass correlation coefficients. RESULTS: Overall mean Leech scores for fecal [6.9 (95% CI 6.7, 7.2)] and renal [7.3 (95% CI 7.1, 7.5)] cohorts were equivalent within a margin of 0.75 (adjusted mean difference: - 0.4 [90% CI - 0.7, - 0.04]; p value = 0.02). Inter-reader agreement was good [ICC: 0.62 (95% CI 0.56, 0.68)]. CONCLUSION: Radiographic stool quantification produces equivalent results in symptomatic and asymptomatic adults and is of uncertain value.

Daily relative dog abundance, fecal density, and loading rates on intensively and minimally managed dog-friendly beaches in central California.

Due to increased concerns regarding fecal pollution at marine recreational beaches, daily relative dog abundance and fecal density were estimated on an intensively managed (Beach 1) and a minimally managed (Beach 2) dog beach in Monterey County, California. Fecal loading and factors predictive of fecal deposition also were assessed. After standardizing for beach area, daily beach use and fecal densities did not differ between beaches and yearly fecal loading estimates revealed that unrecovered dog feces likely contributes significantly to fecal contamination (1.4 and 0.2metrictonnes/beach). Detection of feces was significantly associated with beach management type, transect position relative to mean low tideline, presence of beach wrack, distance to the nearest beach entrance, and season. Methodologies outlined in this study can augment monitoring programs at coastal beaches to optimize management, assess visitor compliance, and improve coastal water quality.

Accuracy of the new radiographic sign of fecal loading in the cecum for differential diagnosis of acute appendicitis in comparison with other inflammatory diseases of right abdomen: a prospective study.

RATIONALE: To assess the importance of the new radiographic sign of faecal loading in the cecum for the diagnosis of acute appendicitis, in comparison with other inflammatory diseases, and to verify the maintenance of this radiographic sign after surgical treatment of appendicitis. METHODS: 470 consecutive patients admitted to the hospital due to acute abdomen were prospectively studied: Group 1 [n=170]--diagnosed with acute appendicitis, subdivided into: Subgroup 1A--[n=100]--submitted to an abdominal radiographic study before surgical treatment, Subgroup 1B--[n=70]--patients who had plain abdominal X-rays done before the surgical procedure and also the following day; Group 2 [n=100]--right nephrolithiasis; Group 3 [n=100]--right acute inflammatory pelvic disease; Group 4 [n=100]--acute cholecystitis. The patients of Groups 2,3 and 4 were submitted to abdominal radiography during the pain episode. RESULTS: The sign of faecal loading in the cecum, characterized by hypo transparency interspersed with multiple small foci of hyper transparent images, was present in 97 patients of Subgroup 1A, in 68 patients of Subgroup 1B, in 19 patients of Group 2, in 12 patients of Group 3 and in 13 patients of Group 4. During the postoperative period the radiographic sign disappeared in 66 of the 68 cases that had presented with the sign. The sensitivity of the radiographic sign for acute appendicitis was 97.05% and its specificity was 85.33%. The positive predictive value for acute appendicitis was 78.94% and its negative predictive value was 98. 08%. DISCUSSION: The radiographic image of faecal loading in the cecum is associated with acute appendicitis and disappears after appendectomy. This sign is uncommon in other acute inflammatory diseases of the right side of the abdomen.

Importância do sinal radiográfico de acúmulo fecal no ceco para o diagnóstico diferencial de apendicite aguda: estudo prospectivo / Importance of the radiographic sign of fecal loading in the cecum for the diferential diagnosis of acute appendicitis: a prospective study

Objetivo: O objetivo do presente trabalho foi verificar a importância do sinal radiográfico de acúmulo fecal no ceco para o diagnóstico diferencial da apendicite aguda. Métodos: Foram estudados prospectivamente 470 pacientes consecutivos, de ambos os sexos, internados com abdome agudo e dor localizada no flanco direito, distribuídos em: Grupo 1 (n=170) - portadores de apendicite aguda, subdistribuídos em: Subgrupo 1A - (n=100) - submetidos a um estudo radiográfico do abdome antes do tratamento cirúrgico - e Subgrupo 1B - (n=70) - submetidos a dois estudos radiográficos do abdome: antes da operação e outro no dia seguinte à cirurgia; Grupo 2 (n=100) - portadores de cálculo na via urinária direita submetidos a radiografia do abdome durante o episódio de dor provocada pela litíase; Grupo 3 (n=100) - portadoras de afecções ginecológicas inflamatórias agudas à direita, submetidas a estudo radiográfico do abdome durante a crise de dor; Grupo 4 (n=100) - pacientes operados por colecistite aguda, submetidos a radiografias de abdome durante o episódio de dor que precedeu ao ato operatório. Resultados: A presença do sinal de acúmulo fecal no ceco esteve presente em 97 pacientes do Subgrupo 1A, em 68 pacientes do Subgrupo 1B, em 19 pacientes do Grupo 2, em 12 pacientes do Grupo 3 e em 13 pacientes do Grupo 4. No pós-operatório, dos 68 pacientes que apresentaram o sinal radiográfico, esse desapareceu em 66 casos. A sensibilidade do sinal radiográfico para apendicite aguda foi de 97,05% e sua especificidade foi de 85,33%. Seu valor preditivo positivo para apendicite aguda foi de 78,94% e destacando-se seu valor preditivo negativo de 98,08%. Conclusões: A imagem radiográfica de acúmulo fecal no ceco se associa a apendicite aguda. Essa imagem geralmente desaparece após o apêndice cecal ser removido. Esse sinal é incomum em outras doenças inflamatórias agudas do lado direito do abdome.

Imagem radiográfica de acúmulo fecal no ceco, como sinal diagnóstico de apendicite aguda / Radiographic image of fecal loading in the cecum as a diagnostic sign of acute appendicitis

OBJETIVO: Apesar de os achados radiográficos de apendicite aguda serem bem documentados, o valor da radiografia simples ainda não foi completamente determinado. O objetivo do presente estudo foi estabelecer a freqüência da associação de apendicite aguda a um sinal radiográfico caracterizado por imagem de acúmulo fecal ocupando todo o ceco. MATERIAIS E MÉTODOS: Foram realizadas radiografias simples de abdome de 100 pacientes consecutivos com apendicite aguda, comprovada por operação e exame anatomopatológico. Pesquisou-se, nas radiografias, a presença de imagem de acúmulo fecal no ceco, caracterizada por hipotransparência ocupando todo o ceco e, eventualmente, também o cólon ascendente. RESULTADOS: A imagem de acúmulo fecal no ceco foi encontrada em 97 por cento dos doentes, independentemente de idade, sexo, cor da pele ou estádio da apendicite. CONCLUSÃO: Este estudo sugere que a presença de imagem radiográfica de acúmulo fecal no ceco pode ser um sinal útil no diagnóstico de apendicite aguda.

OBJECTIVE: Although the radiological features of acute appendicitis are well documented, the value of the plain radiography has not been fully appreciated yet. The present study was aimed at determining the frequency of association between acute appendicitis and a radiological sign characterized as an image of fecal loading in the whole cecum. MATERIALS AND METHODS: Plain abdominal radiographs of 100 consecutive adult patients with acute appendicitis proved by surgery and histology were assessed. The presence of fecal loading characterized by hypotransparency in the whole cecum, and sometimes also in the ascending colon, was observed. RESULTS: The image of fecal loading in the cecum was found in 97 percent of cases of acute appendicitis, independently of age, gender, skin color or stage of appendicitis. CONCLUSION: The present study suggests that the presence of radiological images of fecal loading in the cecum may be a useful sign for the diagnosis of acute appendicitis.