Kanai Risa, Nakaya Kengo, Fukumoto Koji, Yamoto Masaya, Miyake Hiromu, Nomura Akiyoshi, Yamada Susumu, Makino Akihiro, Iwafuchi Hideto, Urushihara Naoto
Department of Pediatric Surgery, Shizuoka Children's Hospital, Address: 860, Urushiyama Aoi-ku Shizuoka-shi, Shizuoka 420-8660, Japan.
Department of Pathology, Shizuoka Children's Hospital, Address: 860, Urushiyama Aoi-ku Shizuoka-shi, Shizuoka 420-8660, Japan.
Case Rep Pediatr. 2021 Feb 2;2021:8815907. doi: 10.1155/2021/8815907. eCollection 2021.
A fecaloma is a mass of accumulated feces with a consistency much harder than that of a fecal impaction. It is most frequently observed in the rectum and sigmoid area, and associated complications include colonic obstruction, ulceration, bleeding, and perforation. A one-year-old, previously healthy boy with no history of chronic constipation was admitted because of vomiting and abdominal distension. An abdominal computed tomography scan showed small and large bowel distension due to multiple obstructive fecalomas in the transverse colon. As the fecalomas could not be resolved by laxatives, enemas, or colonic lavage, endoscopic disimpaction under general anesthesia was attempted. Repeatedly shaving the fecalomas with biopsy forceps finally resulted in gradual fragmentation with subsequent passage. Gastrointestinal food allergy was later suggested as the cause because eosinophilic infiltration was found in a biopsy specimen of the colon wall. Endoscopic disimpaction is an effective treatment approach for addressing fecalomas to avoid more invasive surgical intervention.
粪石是一团积聚的粪便，其硬度远高于粪块嵌塞。它最常出现在直肠和乙状结肠区域，相关并发症包括结肠梗阻、溃疡、出血和穿孔。一名一岁的既往健康男孩，无慢性便秘病史，因呕吐和腹胀入院。腹部计算机断层扫描显示，由于横结肠内多个阻塞性粪石，小肠和大肠均有扩张。由于泻药、灌肠或结肠灌洗均无法清除粪石，因此尝试在全身麻醉下进行内镜下解除粪石嵌塞。用活检钳反复刮除粪石最终使其逐渐破碎并随后排出。后来结肠壁活检标本中发现嗜酸性粒细胞浸润，提示存在胃肠道食物过敏。内镜下解除粪石嵌塞是一种有效的治疗方法，可避免更具侵入性的手术干预。
