Significant Morbidity and Mortality Associated with Fecal Impaction in Patients Who Present to the Emergency Department

Abstract

Background: Fecal impaction (FI) is defined as a large mass of stool in the rectum and/or colon that is unable to be evacuated. No study to date details demographics and outcomes in a sizeable sample of FI patients in the USA.

Aims: The present study aims to develop knowledge of FI by reporting descriptive measures and outcomes of patients presenting to a US emergency department (ED) with FI.

Methods: Medical charts coded with FI at Beth Israel Deaconess Medical Center from 2016 or 2017 were identified retrospectively. Patients diagnosed with FI in the ED or subsequent to direct hospital admission from the ED were included. Patient-specific demographics, visit-specific details, medical and medication histories, and hospital treatment and outcome measures were included in a database and analyzed.

Results: Thirty-two patients (mean age of 72.9 years, 62.5% female) had a total of 42 ED visits with FI. Patients had an average of 8.7 diagnoses and 11.2 medications listed in their charts. 54.8% of patients were taking at least one commonly prescribed constipating medication. The median total length of stay for admitted patients was 3 days, with nearly 90% of the ED visits with FI requiring hospital admission. 40.6% of patients experienced serious FI-related morbidities, and 21.9% of patients with FI died in the hospital.

Conclusion: Patients presenting with FI had high risk of morbidity and mortality, complex medical histories, and large numbers of active treatment regimens. Patients with FI should receive immediate treatment and close monitoring for morbidities and complications.

Keywords: Constipation; Epidemiology; Fecal impaction; Morbidity; Mortality; Opioids.

Figure 1.. Common complaints upon ED presentation.

Bar graph displaying frequencies of commonly reported complaints upon ED presentation for all ED visits with FI. Multiple complaints were typically reported for each visit. *Altered mental status resulted from respiratory complications (3 visits), lactic or metabolic acidosis (3 visits), urinary tract infection (UTI) or urosepsis (2 visits), and metabolic encephalopathy (1 visit)

Figure 2.. Efficacy of disimpaction in the ED.

Flow chart of all ED visits with FI depicting whether or not patients were identified with FI in the ED, whether or not patients had disimpaction attempted in the ED, and whether or not patients were disimpacted successfully using digital maneuvers, enemas/suppositories, or both digital maneuvers and enemas/suppositories.

Figure 3.. Classification of serious FI-related morbidities.

Pie chart revealing the breakdown of serious FI-related morbidities in all patients with ED visits with FI.