Massive sigmoid megacolon due to giant fecaloma: A case report of anal stricture

A fecaloma is a mass of hardened feces in the colon or rectum, more solid than typical impacted feces, leading to severe intestinal distension. It predominantly affects elderly, frail individuals, children with anorectal deformities, and patients with conditions such as Chagas disease, Hirschsprung's disease, and spinal injuries. We report the case of a 34-year-old man with a history of anal imperforation and subsequent anal stricture, who presented with a massive megacolon due to a giant fecaloma. The patient experienced progressive abdominal distension, colicky pain, and an inability to pass stool for 15 days. Physical examination revealed a tender, distended abdomen and impacted feces in the rectum. Laboratory tests and imaging studies confirmed the diagnosis. An emergency laparotomy revealed a 30 × 30 cm dilated sigmoid colon filled with 15–25 kg of fecal material. The fecaloma was removed via enterectomy, and a Hartmann's procedure with colostomy was performed. Histopathological examination showed no evidence of malignancy. Post-operatively, the patient recovered well and was discharged in good condition. This case highlights the presentation and surgical management of a giant fecaloma causing megacolon. Prompt surgical intervention is critical in managing severe fecaloma to prevent life-threatening complications. • Giant fecaloma most commonly affects elderly, frail individuals, children with anorectal deformities, and may also be associated with various conditions such as Chagas disease, Hirschsprung's disease, inflammatory disorders, psychiatric and neoplastic disorders. • Serious consequences including stercoral perforations of the colon and rectum may also arise from untreated fecaloma. • Conservative management of fecaloma includes laxatives, enemas, or digital evacuation, but these methods require access to the rectum, often restricted by anal strictures. Surgical intervention becomes necessary when conservative measures are impeded, ensuring effective management in cases of significant anal strictures. • Patients that are bed-bound, with psychiatric illness, Hirschsprung's or Chagas disease and with previous history of anal surgery should always be considered for risk of developing chronic constipation and fecaloma.