Giant fecaloma: Can early surgical intervention prevent stercoral peritonitis?

Fecaloma, an accumulation of hardened fecal matter, is a clinical challenge that most often occurs in the rectum and sigmoid colon, rarely in the rest of the colon. Often overlooked, fecalomas can potentially lead to serious complications such as obstruction and perforation. Conservative management of fecaloma typically involves the use of laxatives, enemas, or digital disimpaction. However, when conservative methods are ineffective surgical intervention is required. This article presents a rare case of a 54-year-old patient with a history of tuberculous meningoradiculitis and chronic constipation, leading to a giant fecaloma presenting with severe abdominal distension. Despite conservative measures, including enemas and dietary care, the patient developed stercoral peritonitis and sigmoid colonic perforation necessitating late surgical intervention leading to death. This case allows us to engage in discussions over the correct management of this entity which is often underestimated by healthcare practitioners particularly by surgeons.