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Cecal fecaloma due to intestinal tuberculosis: endoscopic treatment.

Kim SM, Ryu KH, Kim YS, Lee TH, Im EH, Huh KC, Choi YW, Kang YW - Clin Endosc (2012)

Bottom Line: The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site.Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment.Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT
Colorectal fecaloma is a mass of accumulated feces that is much harder in consistency than a fecal impactation. The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site. Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, endoscopic procedures or a surgical intervention may be needed. We report here that a cecal fecaloma caused by intestinal tuberculosis scar was successfully removed by endoscopic procedures.

No MeSH data available.


Related in: MedlinePlus

(A) Colonoscopic view of breaking down the fecaloma with a polypectomy snare. (B) Colonoscopy reveals the lumen of the cecum after the fecaloma was successfully removed by the endoscopic procedure.
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Figure 4: (A) Colonoscopic view of breaking down the fecaloma with a polypectomy snare. (B) Colonoscopy reveals the lumen of the cecum after the fecaloma was successfully removed by the endoscopic procedure.

Mentions: A 30-year-old female presented with a 2-month history of intermittent pain and a palpable mass in the right lower quadrant of the abdomen. She had a history of chronic constipation with about 2 bowel movements per week and hard stools. Five years earlier, she had undergone an appendectomy. She was diagnosed with pulmonary tuberculosis 9 months ago and was taking antituberculosis therapy. Her height was 163 cm and her weight was 49 kg. Physical examination revealed mild abdominal tenderness and a ping-pong ball-sized movable mass in the right lower quadrant of the abdomen. An abdominal computed tomography (CT) scan showed a 3.0-cm, round, laminated intraluminal mass with calcification in the cecum (Fig. 1A, B). Colonoscopy revealed fibrotic scar tissue probably due to intestinal tuberculosis in the ascending colon and a web-like stricture in the cecum around a patulous ileocecal valve. In a blind space which was formed by the stricture, a yellowish mass was found (Fig. 2). We could not insert a fiberoptic colonoscope into the cecum, and dilatation was thus performed using a th-rough-the-scope balloon (CRE balloon; Boston Scientific Co., Marlborough, MA, USA) with a diameter of 12 to 15 mm on inflation (Fig. 3). After endoscopic balloon dilatation, the colonoscope was able to pass into the cecum, and a 3.0-cm, yellowish fecaloma was observed. We broke down the fecaloma with a polypectomy snare and grasping forceps. The fecaloma was successfully removed by using a water jet and grasping forceps through the endoscopic procedure (Fig. 4A, B; Supplementary Video 1 online). There was no ulcer in the cecal base. Three mo-nths later, her symptoms improved, and there was no evidence of fecaloma recurrence.


Cecal fecaloma due to intestinal tuberculosis: endoscopic treatment.

Kim SM, Ryu KH, Kim YS, Lee TH, Im EH, Huh KC, Choi YW, Kang YW - Clin Endosc (2012)

(A) Colonoscopic view of breaking down the fecaloma with a polypectomy snare. (B) Colonoscopy reveals the lumen of the cecum after the fecaloma was successfully removed by the endoscopic procedure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3401624&req=5

Figure 4: (A) Colonoscopic view of breaking down the fecaloma with a polypectomy snare. (B) Colonoscopy reveals the lumen of the cecum after the fecaloma was successfully removed by the endoscopic procedure.
Mentions: A 30-year-old female presented with a 2-month history of intermittent pain and a palpable mass in the right lower quadrant of the abdomen. She had a history of chronic constipation with about 2 bowel movements per week and hard stools. Five years earlier, she had undergone an appendectomy. She was diagnosed with pulmonary tuberculosis 9 months ago and was taking antituberculosis therapy. Her height was 163 cm and her weight was 49 kg. Physical examination revealed mild abdominal tenderness and a ping-pong ball-sized movable mass in the right lower quadrant of the abdomen. An abdominal computed tomography (CT) scan showed a 3.0-cm, round, laminated intraluminal mass with calcification in the cecum (Fig. 1A, B). Colonoscopy revealed fibrotic scar tissue probably due to intestinal tuberculosis in the ascending colon and a web-like stricture in the cecum around a patulous ileocecal valve. In a blind space which was formed by the stricture, a yellowish mass was found (Fig. 2). We could not insert a fiberoptic colonoscope into the cecum, and dilatation was thus performed using a th-rough-the-scope balloon (CRE balloon; Boston Scientific Co., Marlborough, MA, USA) with a diameter of 12 to 15 mm on inflation (Fig. 3). After endoscopic balloon dilatation, the colonoscope was able to pass into the cecum, and a 3.0-cm, yellowish fecaloma was observed. We broke down the fecaloma with a polypectomy snare and grasping forceps. The fecaloma was successfully removed by using a water jet and grasping forceps through the endoscopic procedure (Fig. 4A, B; Supplementary Video 1 online). There was no ulcer in the cecal base. Three mo-nths later, her symptoms improved, and there was no evidence of fecaloma recurrence.

Bottom Line: The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site.Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment.Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT
Colorectal fecaloma is a mass of accumulated feces that is much harder in consistency than a fecal impactation. The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site. Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, endoscopic procedures or a surgical intervention may be needed. We report here that a cecal fecaloma caused by intestinal tuberculosis scar was successfully removed by endoscopic procedures.

No MeSH data available.


Related in: MedlinePlus