Successful Resolution of Fecal Impaction During Endoscopy Using a Looped Guidewire

Abstract

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.

Keywords: colonography; conservative treatment; disimpaction; endoscopy; fecal impaction.

Fig. 1.

Computed tomography findings. A large fecal mass was observed in the sigmoid colon (red arrowheads).

Fig. 2.

Colonoscopy findings. A mass of yellowish-brown feces occupied the lumen of the sigmoid colon.

Fig. 3.

Retrograde sigmoidoscopy colonography findings. The mass of feces was spherical and 44.7 mm in diameter (red arrowheads).

Fig. 4.

Looped-wire endoscope. A guidewire was maneuvered to form a large loop at the tip of the endoscope. The loop was expanded to encircle the feces.

Fig. 5.

X-ray fluoroscopy findings. The fecal mass was encircled with the looped-guidewire (a) and bisected by the contraction of the loop (b). The line of bisection was visible (red arrowheads).