Massive Fecal Impaction with Megacolon Mimicking Perforation Peritonitis. A Case Report and Review of Literature.: Fecal Impaction Mimicking Peritonitis

Abstract

Introduction: Massive fecal impaction with megacolon represents an uncommon yet serious complication of chronic constipation and can mimic acute abdominal emergencies, including perforation peritonitis.

Case Presentation: A 60-year-old woman with a 5-year history of chronic constipation and irregular laxative use presented with progressive abdominal distension, vomiting, and obstipation. Clinical examination revealed diffuse abdominal guarding and an empty rectum. Imaging findings suggested pneumoperitoneum, prompting emergency laparotomy. Intraoperatively, the cecum, ascending colon, and transverse colon were found to be massively dilated with extensive fecal loading up to the splenic flexure and impending cecal perforation. The radiographic appearance of air under the diaphragm was attributable to the dilated hepatic flexure abutting the diaphragm. Subtotal colectomy with end ileostomy was performed, and postoperative recovery was uneventful.

Conclusion: This case underscores fecal impaction as a potentially life-threatening consequence of chronic constipation, particularly in elderly patients. Misinterpretation of radiological findings can delay diagnosis. Timely recognition and prompt surgical intervention are essential to prevent catastrophic outcomes, including perforation and peritonitis. Increased clinical awareness of these risks is crucial for reducing morbidity.