Fecal Impaction Management

Diagnosis and Treatment

• The World Journal of Emergency Surgery recommends that the evaluation of fecal impaction should include laboratory tests for inflammatory markers such as white blood cell count and C-reactive protein 1, 2.
• In cases of late presentation (>12 hours), the level of procalcitonina may be useful for diagnosis 2.
• Abdominal radiographs in the vertical or decubitus position can detect small amounts of free peritoneal air, but are insensitive to the presence of fluid 1.
• If clinical suspicion persists after a normal radiograph, a computed tomography (CT) scan with contrast should be requested, as it can easily detect small amounts of free air and fluid in the peritoneum 1, 2.
• Ultrasound may be useful in cases where radiation load should be limited, such as in children and pregnant women 1.
• The Annals of Oncology recommends that management of fecal impaction involves disimpaction (usually by digital fragmentation and extraction of feces), followed by implementation of a maintenance bowel regimen to prevent recurrence 3.
• For distal fecal impaction, digital fragmentation of feces is recommended, followed by enema (water or oil retention) or suppository to facilitate passage through the anal canal 3.
• Once the distal colon has been partially emptied with disimpaction and enemas, polyethylene glycol (PEG) can be administered orally 3.
• In cases of proximal fecal impaction and in the absence of complete intestinal obstruction, lavage with PEG solutions containing electrolytes can help soften or eliminate feces 3.
• Osmotic laxatives (PEG, lactulose, or magnesium and sulfate salts) or stimulant laxatives (senna, cascara, bisacodyl, and sodium picosulfate) are preferred options when laxatives are needed 3.
• Suppositories and enemas are a preferred first-line therapy when digital rectal examination identifies a full rectum or fecal impaction 3.

Complications

• The Annals of Oncology states that complications of fecal impaction, although rare, include urinary tract obstruction, colonic perforation, dehydration, electrolyte imbalance, renal failure, fecal incontinence, pressure ulcers, stercoral ulcers, and rectal bleeding 3.