Presentation
Patient with a history of colon surgery since one month, presented with right-sided abdominal pain. She didn't pass stool for 16 hours.
Patient Data
The right lumbar region shows an area of mottled gas suggestive of retained bowel contents. Decreased bowel gas in otherwise areas of the abdomen.
Focally dilated bowel loop with retained fecal matter measuring 13 x 8.5 x 11 cm in AP, SS and CC dimensions with dilated proximal bowel loop segment and collapsed distal bowel. Luminal narrowing is seen at the anastomotic site defined by the suture lines (ilio-transverse anastomosis) with proximal fecaloma formation.
Normal bowel wall features with normal enhancement and no signs of ischemia. No signs of inflammatory changes or masses. No pneumoperitoneum. Mild free fluid at the pelvis.
Infra-umbilical midline incisional hernia with wide neck transmitting collapsed bowel loops.
Case Discussion
The patient had a history of right hemicolectomy for adenomatous polyp. CT features are suggestive of acute bowel obstruction at the site of ilio-transverse anastomosis with the formation of proximal fecaloma.
Fecaloma at the anastomotic site is rare and can be treated with colonoscopic mechanical fragmentation in patients without an absolute indication for surgery 1. Risk factors for post-colectomy fecaloma include female gender, left-side colonic anastomosis, and functional end-to-end anastomosis 1.
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