Significant Morbidity and Mortality Associated with Fecal Impaction in Patients Who Present to the Emergency Department.

BACKGROUND: Fecal impaction (FI) is defined as a large mass of stool in the rectum and/or colon that is unable to be evacuated. No study to date details demographics and outcomes in a sizeable sample of FI patients in the USA. AIMS: The present study aims to develop knowledge of FI by reporting descriptive measures and outcomes of patients presenting to a US emergency department (ED) with FI. METHODS: Medical charts coded with FI at Beth Israel Deaconess Medical Center from 2016 or 2017 were identified retrospectively. Patients diagnosed with FI in the ED or subsequent to direct hospital admission from the ED were included. Patient-specific demographics, visit-specific details, medical and medication histories, and hospital treatment and outcome measures were included in a database and analyzed. RESULTS: Thirty-two patients (mean age of 72.9 years, 62.5% female) had a total of 42 ED visits with FI. Patients had an average of 8.7 diagnoses and 11.2 medications listed in their charts. 54.8% of patients were taking at least one commonly prescribed constipating medication. The median total length of stay for admitted patients was 3 days, with nearly 90% of the ED visits with FI requiring hospital admission. 40.6% of patients experienced serious FI-related morbidities, and 21.9% of patients with FI died in the hospital. CONCLUSION: Patients presenting with FI had high risk of morbidity and mortality, complex medical histories, and large numbers of active treatment regimens. Patients with FI should receive immediate treatment and close monitoring for morbidities and complications.

Fecal impaction: a systematic review of its medical complications.

BACKGROUND: Fecal impaction (FI) is a common problem in the elderly and other at-risk groups, such as patients with a neuro-psychiatric disease. It has been associated with medical problems and high morbi-mortality. A systematic review of this topic might be useful to improve the knowledge in this area and helpful to make an appropriate and early diagnosis. METHODS: A PubMed systematic search was performed using relevant keywords. Case reports published in English, Spanish or French till June 2014 were included if they had a diagnosis of FI and a medical complication secondary to it. Each case was classified based on its principal complication. The main objective is to create a classification of FI complications based on published clinical cases. RESULTS: 188 articles met inclusion criteria, comprising 280 clinical cases. Out of the total, 43,5% were over 65 years old, 49% suffered from chronic constipation, 29% had an underlying neuropsychiatric disease and 15% were hospitalised or institutionalised. A total of 346 medical complications secondary to FI were collected. They were divided according to gastrointestinal tract involvement and then classified based on their anatomical and pathophysiological mechanism into three groups: Complications secondary to fecaloma effect on the intestinal wall (73.4%), on the intestinal lumen (14%) and on adjacent structures (12.6%). CONCLUSIONS: FI causes complications that might be fatal. The elderly, underlying neuropsychiatric disease and hospitalised or institutionalised patients integrate the high-risk group in which FI must be suspected. The first FI complications classification is presented to improve the knowledge about this entity.

Outcome of Surgical and Medical Management of Cecal Impaction in 150 Horses (1991-2011).

OBJECTIVE: To evaluate short- and long-term outcome after medical and surgical management of horses with cecal impaction and to determine reasons for death or euthanasia. STUDY DESIGN: Retrospective case series. ANIMALS: Horses (n = 150). METHODS: Data collected from medical records (1991-2011) of horses with a diagnosis of cecal impaction, included signalment, history of recent disease/surgical procedure, admission data, management (medical, typhlotomy alone, jejunocolostomy), complications, and outcome. Short-term outcome (alive or dead at discharge) and long-term outcome (alive or dead at ≥1 year) were determined by telephone interview. Data were analyzed using a χ(2) or Fisher's exact test. Level of significance was P < .05. RESULTS: Of 150 horses hospitalized with a diagnosis of cecal impaction, 102 (68%) had a history of recent disease or a surgical procedure. Thirty-eight horses (25%) had cecal perforation at admission and 3 horses (2%) were euthanatized without treatment. Of 109 horses treated, 59 (54%) were managed medically and 50 (46%) surgically (typhlotomy [26]; jejunocolostomy [24]). The proportion of horses alive at hospital discharge was significantly lower for horses managed medically (61%) compared with surgically (82%; P = .02) but there was no difference between horses managed with typhlotomy alone (77%) or with jejunocolostomy (88%; P = .47). There were 57% of horses managed medically alive at 1 year. There was a similar proportion of horses alive at 1 year after typhlotomy alone (73%) and jejunocolostomy (70%; P = .86). CONCLUSIONS: Compared to the recent reports, the proportion of horses alive at hospital discharge was lower for both medically and surgically managed horses with cecal impaction. There was decreased survival for horses treated medically than those treated surgically; however, no significant difference was seen in survival between horses managed with typhlotomy alone versus jejunocolostomy.

Value of CT in the discrimination of fatal from non-fatal stercoral colitis.

OBJECTIVE: Clinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC. MATERIALS AND METHODS: Ten patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports. RESULTS: SC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p = 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC. CONCLUSION: CT appears to be valuable in discriminating fatal from non-fatal SC.

Value of CT in the Discrimination of Fatal from Non-Fatal Stercoral Colitis

OBJECTIVE: Clinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC. MATERIALS AND METHODS: Ten patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports. RESULTS: SC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p = 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC. CONCLUSION: CT appears to be valuable in discriminating fatal from non-fatal SC.

Fecaloma. Tratamiento de las complicaciones agudas / Fecaloma. Treatment of the acute complications

Antecedentes: Se define como fecaloma o bolo fecal, a la acumulación de materia fecal en el recto y/o colon sigmoides, de un volumen y consistencia tal que hacen imposible su eliminación por medios naturales. Objetivos: Describir las características clínicas de esta población, cuantificar su frecuencia como causa de oclusión colónica, ponderar la relación entre el tiempo de evolución y la presencia de patología colónica asociada con la necesidad de tratamiento quirúrgico, y evaluar morbimortalidad de la serie. Diseño: Observacional, descriptivo, retrospectivo. Material y método: Entre enero de 1998 y diciembre de 2004 fueron internados en la Clínica Modelo de Lanús, 19 pacientes con una complicación derivada de un fecaloma. En 18 (94,7 por ciento) el cuadro fue de oclusión intestinal, y en el restante se trató de un abdomen agudo peritoneal por una úlcera estercorácea. Resultados: La edad promedio fue de 73,5 ± 13,9 años, y en relación al sexo, hubo 11 mujeres (57,8 por ciento) y 8 hombres (42,2 por ciento). De los 18 pacientes con cuadros oclusivos, en 13 se resolvió e1 mismo sin necesidad de tratamiento quirúrgico. En los 5 restantes, al igual que en el paciente que se presentó con una úlcera estercorácea, se debió recurrir a la cirugía. En la oclusión, el tiempo de evolución, fue de 5,6 días en los casos operados, y de 4,3 en los no operados (p = 0,48125). Los 3 casos con megacolon debieron ser operados, mientras que esto fue necesario en sólo el 13,3 por ciento de los enfermos sin megacolon (p = 0,014). La morbilidad fue del 31.5 por ciento y la mortalidad global fue del 15.7 por ciento, aunque sólo un óbito ocurrió como consecuencia directa del fecaloma (5,2 por ciento). Conclusiones: El fecaloma es una entidad frecuente como causa de obstrucción colónica, las medidas conservadoras resuelven la mayoría de los casos. No se observó una diferencia significativa entre el tiempo de evolución del cuadro obstructivo y el resultado del tratamiento médico. Si fue significativa la necesidad de operar a los pacientes que presentan patología colónica asociada con respecto a aquellos que no la tienen. La morbimortalidad es elevada y está relacionada con las enfermedades concomitantes.

Large colon impaction in horses: 147 cases (1985-1991)

Medical records from all horses with large colon impaction admitted between 1985 and 1991 were examined. Large colon impaction was diagnosed in 147 of 1,100 (13.4%) horses with colic. One hundred thirty horses were admitted for further evaluation of acute onset of abdominal pain after having been examined and treated by referring veterinarians, and 17 horses that were hospitalized for unrelated medical problems developed large colon impaction. Female horses (92/147; 62.6%) were more commonly affected than males. The age ranged from 1 to 29 years (median, 7.1 years). Mean duration of clinical signs of abdominal pain prior to referral was 32 hours. At admittance, signs of abdominal pain were not detectable in 70/147 (48%) horses, and were mild in 50 (34%), moderate in 16 (11%), and severe in 11 (7%). Heart rate ranged from 30 to 86 beats/min (median, 44 beats/min), and most horses had a decrease in gastrointestinal sounds. Transrectal palpation was used to identify the impaction location as being the pelvic flexure in 103 (70.1%) horses, colon on the left side in 30 (20.4%) horses, and colon on the right side in 14 (9.5%) horses. All 147 horses received fluids i.v. and nonsteroidal anti-inflammatory medications or sedatives, including flunixin meglumine (124 horses, 84.3%) xylazine hydrochloride (81, 55%), butorphanol (6, 0.04%), and detomidine hydrochloride (9, 0.04%). Duration of medical treatment required to resolve the impaction ranged from 1 to 6 days (mean, 2 days). In addition to medical treatment, 24 (16.3%) horses also required surgery.(ABSTRACT TRUNCATED AT 250 WORDS)