Obstructive Colitis Due to Fecal Impaction: A Case Report and Review of the Literature

A 63-year-old woman had noted intermittent abdominal pain two hours before she came to our hospital, which got worse after the use of a laxative (enema). Although there was no remarkable problem in her physical examination, she was admitted to our hospital for observation. Her symptoms got worse 9 hours after the onset, and she became unconsciousness, with tachycardia and tachypnea 2 hours later. CT revealed fecal impaction in the sigmoid colon and severe dilation of the proximal colon with pneumatosis intestinalis and portal venous gas. We performed an emergency laparotomy on a diagnosis of obstructive colitis due to fecal impaction and septic shock. The sigmoid colon was obstructed with feces and the bowel from the sigmoid colon to the end of ileum was totally necrotized. Subtotal colectomy with ileostomy was performed. She recovered with postoperative management including catecholamine support and endotoxin absorption. The obstructive colitis due to fecal impaction is very rare. We report our case with a literature review of 13 cases of obstructive colitis due to fecal impaction in Japan.