An Obstructing Fecal Bezoar in a Patient with Scleroderma with Successful Colonoscopic Disimpaction

Abstract

Scleroderma (SSc) is a disease caused by collagen deposition resulting in fibrosis within multiple organs, including the gastrointestinal tract, skin, joints, kidneys, lungs, and heart. We report a rare case of a patient with diffuse SSc who presented with a large bowel obstruction from a fecal bezoar impaction. The bezoar was successfully removed using colonoscopy after lavage, cold forceps, balloon dilator, and cap-assisted disimpaction. We demonstrate that patients with SSc are at risk for bezoar formation and true mechanical obstruction in the lower gastrointestinal tract, which may require more aggressive endoscopic treatment if conservative measures fail.

Figure 1.

Contrast-enhanced abdominal computed tomography. (A) Axial view showing 4.6 × 5.7 cm mass with mottled appearance consistent with fecal bezoar in transverse colon along with inflammatory bowel wall thickening. (B) Coronal view showing moderate diffuse fluid-filled distention of loops of small and large bowel proximal to fecal bezoar in the proximal transverse colon, consistent with a developing upstream large and small bowel obstruction.

Figure 2.

Plain abdominal radiograph showing the 6-cm fecal bezoar, unchanged in location in the transverse colon.

Figure 3.

Colonoscopy showing (A) the full view of fecal bezoar in transverse colon prior to disimpaction, and (B) the fecal bezoar lodged in the hepatic flexure of the transverse colon prior to disimpaction.