Okada Tomoyuki, Yanagitani Atsushi, Hashimoto Takeshi, Isomoto Hajime
Tottori Prefectural Central Hospital, Tottori 680-0901, Japan and.
Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan.
Yonago Acta Med. 2021 Jan 15;64(1):129-132. doi: 10.33160/yam.2021.02.015. eCollection 2021 Feb.
Fecal impaction is the impaired excretion of a large fecal mass, and mild cases are treated by enema and osmotic laxatives. However, treatment-resistant cases need more invasive alternatives. A woman in her 60s presented with abdominal discomfort. Her abdomen was soft and without tenderness. Computed tomography revealed a large mass of feces in her sigmoid colon and no intestinal dilatation proximal to the mass. Endoscopy confirmed a fecal mass occupying the lumen. A glycerin enema, oral administration of polyethylene glycol, and enteral administration of amidotrizoic acid during colonoscopy were ineffective. We maneuvered a guidewire to form a loop at the tip of an endoscope, with which we subdivided the mass for successful removal. The patient's abdominal discomfort disappeared immediately. Endoscopic disimpaction is far less invasive than surgery and should be considered when treating fecal impaction cases, without severe obstructive colitis, which are nonresponsive to conservative treatment.
粪嵌塞是指大量粪便排出受损，轻度病例通过灌肠和渗透性泻药治疗。然而，难治性病例需要更具侵入性的替代方法。一名60多岁的女性出现腹部不适。她的腹部柔软，无压痛。计算机断层扫描显示乙状结肠内有大量粪便，肿块近端无肠扩张。内镜检查证实有粪块占据肠腔。甘油灌肠、口服聚乙二醇以及结肠镜检查期间肠内给予泛影酸均无效。我们在内镜尖端操纵导丝形成一个环，用这个环将粪块细分以便成功取出。患者的腹部不适立即消失。内镜下解除粪嵌塞的侵入性远低于手术，在治疗对保守治疗无反应且无严重梗阻性结肠炎的粪嵌塞病例时应予以考虑。
