Homma Yuko, Mimura Toshiki, Sadatomo Ai, Koinuma Koji, Horie Hisanaga, Lefor Alan Kawarai, Sata Naohiro
Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Japan.
Case Rep Gastroenterol. 2021 Dec 27;15(3):994-1002. doi: 10.1159/000521127. eCollection 2021 Sep-Dec.
Fecalomas most commonly occur in constipated patients and are rarely reported after colectomy. A 55-year-old Japanese female presented with a fecaloma after colectomy, which was impacted at a functional end-to-end anastomosis (FEEA) site. Four and a half years ago, she underwent sigmoidectomy for colon cancer. A follow-up computed tomography (CT) scan revealed an 11 cm incidental fecaloma. The patient was advised to undergo surgery, but she desired nonoperative management because of minimal symptoms, and was referred to our institution. On the day of admission (day 1), mechanical fragmentation of the fecaloma was attempted during the first colonoscopy. Although a large block of stool was evacuated after a second colonoscopic fragmentation on day 8, the third colonoscopy on day 21 and CT scan on day 22 showed no significant change in the fecaloma. Frequent colonoscopic fragmentation was performed, with a fourth, fifth, and sixth colonoscopy on days 24, 29, and 31, respectively. After the size reduction was confirmed at the sixth colonoscopy, the patient was discharged home on day 34. The fecaloma completely resolved after the seventh colonoscopic fragmentation on day 44. Sixteen months after treatment, there is no evidence of recurrent fecaloma. According to the literature, risk factors for fecaloma after colectomy include female gender, left-side colonic anastomosis, and FEEA. FEEA might not be recommended for anastomoses in the left colon, particularly in female patients, to avoid this complication. Colonoscopic fragmentation is recommended for fecalomas at an anastomotic site after colectomy in patients without an absolute indication for surgery.
粪石瘤最常见于便秘患者，结肠切除术后很少有报道。一名55岁的日本女性在结肠切除术后出现粪石瘤，其嵌顿在功能性端端吻合（FEEA）部位。4年半前，她因结肠癌接受了乙状结肠切除术。后续的计算机断层扫描（CT）显示一个11厘米的偶然发现的粪石瘤。患者被建议接受手术，但由于症状轻微，她希望进行非手术治疗，并被转诊至我院。入院当天（第1天），在首次结肠镜检查时尝试对粪石瘤进行机械破碎。尽管在第8天进行第二次结肠镜破碎后排出了一大块粪便，但在第21天的第三次结肠镜检查和第22天的CT扫描显示粪石瘤没有明显变化。随后频繁进行结肠镜破碎，分别在第24、29和31天进行了第四次、第五次和第六次结肠镜检查。在第六次结肠镜检查确认粪石瘤体积缩小后，患者于第34天出院。在第44天进行第七次结肠镜破碎后，粪石瘤完全消失。治疗16个月后，没有粪石瘤复发的迹象。根据文献，结肠切除术后粪石瘤的危险因素包括女性、左侧结肠吻合和FEEA。为避免这种并发症，对于左侧结肠的吻合，尤其是女性患者，可能不建议采用FEEA。对于没有绝对手术指征的结肠切除术后吻合口处的粪石瘤，建议采用结肠镜破碎治疗。
