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CASE REPORT
& Hastal›klar› Dergisi
Journal of Diseases of the Colon and Rectum Complicated Fecalith Impaction in a Patientwith Psychosis ‹LHAN KARABIÇAK, TU⁄RUL KES‹C‹O⁄LU, FERKAT AYRANCILAR19 May›s Universitesi T›p Fakültesi, Genel Cerrahi Anabilim Dal› Samsun-Türkiye Elli alt› yafl›nda kad›n hasta, abdominal distansiyon ile A 56-year-old woman presented to the emergency acil servise baflvurdu. Psikoz nedeniyle 15 senedir department with severe abdominal distention. She was risperidon, clorpromazin, biperiden kullanmaktayd›.
under treatment of psychosis with Risperdal® (risperidone) Tan›sal testler rektosigmoid kolonda t›kanmaya iflaret and Largactil® (Chlorpromazine hydrochloride) for 15 etmekteydi. Acil laparotomi ile fekolit ç›kar›ld›. Cerrahi years. She was taking akineton (Biperiden HCL) to sonras› incelemede, kulland›¤› ilaçlar d›fl›nda fekal prevent side effects of the anti-psychotic treatment.
t›kan›kl›¤a neden olabilecek unsura rastlanmad›.
Diagnostic studies revealed severe faecal impaction in the rectosigmoid colon. Emergency laparotomy was Anahtar kelimeler: Fekalit, ‹ntestinal obstrüksiyon, performed and impacted fecalith was removed.
All the diagnostic studies after the surgery were inconclusive for the reason of the fecalith impaction other than her medication for psyhosis.
Key words: Fecalith impaction, Intestinal obstruction, Baflvuru Tarihi: 09.12.2010, Kabul Tarihi: 11.02.2011 Genel Cerrahi Anabilim Dal› Samsun - Türkiye Kolon Rektum Hast Derg 2011;21:28-30 sigmoid colon with fecalith and dilated bowel loops Constipation with fecal impaction is a common and above the impaction. Evacuation of the fecalith was u s u a l l y o v e r l o o k e d p r o b l e m . F e c a l o m a i s attempted with failure. We decide to emergent laparotomy frequently radiopaque and is usually seen at the since her abdominal girth significantly increased the day rectosigmoid colon.1 Causes of fecal impaction include gender (women), socioeconomic status, low intake of Emergency laparotomy showed the whole large bowel dietary fiber, dehydration, immobility, alcohol ingestion, was extremely distented. The sigmoid colon and rectum anti-psychosis drugs, hypothroidism.2,3 In this report, were markedly dilated, thickened, and very redundant we present a case with anti-psychosis treatment who had with a firm intraluminal mass. The bladder also was complications secondary to fecalith impaction and needed extremely distended (3 liters of urine aspirated during the surgery) (Fig. 1-3). Since the patient has pelvic anatomic abnormality, we could not dissect down to the A 56-year-old woman presented with abdominal pain A sigmoid colotomy was performed and all the calcified and distention which started four weeks prior to admission fecal mass were removed. After the removal of the to our clinic. The relatives of the patient stated her content the diameter of the sigmoid colon was more than abdominal distention increased last ten days. A review 20 cm. The inside of the sigmoid colon and rectum was of systems and physical examination showed a markedly inspected to rule out any intraluminal pathology to distended abdomen and deep vein thrombosis in the left explain the fecalith impaction. Then Devine ostomy was leg secondary to abdominal distention. She had a prominent kyphoscoliosis. The patient with life long constipation was living alone and her relatives gave the history since she was unsociable. She was under treatment of psychosis with Risperdal® (risperidone) and Largactil® (Chlorpromazine hydrochloride) for 15 years. The patient had tremors which is a known side effect of Risperdal (Parkinson like effect). She was taking akineton (Biperiden HCL) to prevent side effects of anti-psychotic treatment. Her thyroid hormon levels were within normal limits and there was no sign of any chronic metabolic disease. The CT scan showed extremely distended Figure 2. Distended bladder with 3 liters of urine and distendedtransverse colon. performed. During the postoperative follow-up period, a rectoscopy and biopsy of the rectum was performed which did not show any additional findings to explain the cause of impaction. Urologic evaluation did not show any organic abnormality, too. The urinary retention is considered due to medications. Now the patient is on postoperative third month and waiting for colostomy Figure 1. Extremely distended abdomen and deep vein thrombosis in the left leg secondary to compression of fecalith- Constipation with fecal impaction is a common and usually overlooked problem. Fecaloma is frequently constipating drugs, hypothroidism.2 She was under treatment of psychosis with Risperdal® (risperidone) and Largactil® (Chlorpromazine hydrochloride) for 15 years. The patient had tremors which is a known side effect of risperdal (Parkinson like effect). She was taking akineton (Biperiden HCL) to prevent side effects of anti- psychotic treatment. The known intestinal and urinary side effects of risperidone and biperiden are; constipation and urinary retention.3 We could not find any reason for her constipation other than these medications.5 Her thyroid hormon levels were within normal limits, and there was no sign of any chronic metabolic disease. Fecal impaction may cause stercoral ulceration, bowel obstruction and perforation, sigmoid volvulus, fecal incontinence, rectal prolapse, urinary retention, hydronephrosis, deep venous thrombosis, lower limb ischemia, massive gangrene.4,7 Fecal impaction rarely Figure 3. Extremely distended rectum and sigmoid colon with requires surgical intervention but surgical intervention may be needed for removal of the fecaloma in patients radiopaque and is usually seen at the rectosigmoid colon.1 with complications such as bowel perforation and Causes of fecal impaction include gender (women), volvulus or if conservative measures fail, as in our socioeconomic status, low intake of dietary fiber, dehydration, immobility, alcohol ingestion, use of 1. Rajagopal A, Martin J. Giant fecaloma with and fecal impaction: an unusual case of bilateral idiopathic sigmoid megacolon: report of a case and hydronephrosis. Am Surg 1995;61:709-13.
review of the literature. Dis Colon Rectum 6. Hoballah JJ, Chalmers RT, Sharp WJ, et al. Fecal impaction as a cause of acute lower limb ischemia.
2. Creason N, Sparks D. Fecal impaction: A review 7. Senati E, Coen LD. Massive gangrene of the colon 3. Rege S, Lafferty T. Life-threatening constipation a complication of fecal impaction: report of a case.
associated with clozapine. Australas Psychiatry 8. Altomare DF, Rinaldi M, Sallustio PL, et al. Giant 4. Alvarez C, Hernández MA, Quintano A. Clinical fecaloma in an adult with severe anal stricture caused challenges and images in gi: Image 2: Deep venous by anal imperforation treated by proctocolectomy thrombosis due to idiopathic megarectum and giant and ileostomy: report of a case. Dis Colon Rectum fecaloma. Gastroenterology 2006;131:702-3.
5. Claffey KB, Patton ML, Haith LR Jr, et al. Barium

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