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<p>A 53-year-old man admitted for hypertensive intracranial haemorrhage, developed abdominal pain, pseudo-diarrhoea and a fall in kidney function (CKD-EPI from 74 to 50 mL/min/1.73 m²) with preserved urine output. Abdominopelvic computed tomography demonstrated a large rectosigmoid fecaloma with pancolonic fecal loading, leftward displacement of the bladder and bilateral hydronephrosis (anteroposterior renal pelvic diameters 41 mm on the right and 27 mm on the left), without intrinsic urinary obstruction or colonic perforation/ischemia. After failed and poorly tolerated enemas, urgent manual disimpaction under general anaesthesia with rectal saline lavage (around four litres) produced a massive evacuation estimated at ten kilograms. The early course was favourable: clinical improvement, no need for urinary diversion, recovery of kidney function to 62 mL/min/1.73 m², and ultrasound confirmation of decompression with reduction of renal pelvic diameters from 41 to 34 mm on the right and from 27 to 8 mm on the left. This case highlights the diagnostic and therapeutic value of CT and the effectiveness of prompt relief of distal obstruction in compressive fecalomas complicated by obstructive uropathy. Consent for publication was obtained; identity masked.</p>

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Giant Fecaloma Induced Bilateral Hydronephrosis: Renal Recovery Following Manual Disimpaction

  • 期刊论文

  • 发表日期：

    2025年11月24日

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  • Mohamed Fares Mahjoubi,
  • Mordi Abdelkader,
  • Mignot Hubert,
  • Hazane Eric,
  • Durand-Dastes Flavien,
  • Riff Yannick

摘要

A 53-year-old man admitted for hypertensive intracranial haemorrhage, developed abdominal pain, pseudo-diarrhoea and a fall in kidney function (CKD-EPI from 74 to 50 mL/min/1.73 m²) with preserved urine output. Abdominopelvic computed tomography demonstrated a large rectosigmoid fecaloma with pancolonic fecal loading, leftward displacement of the bladder and bilateral hydronephrosis (anteroposterior renal pelvic diameters 41 mm on the right and 27 mm on the left), without intrinsic urinary obstruction or colonic perforation/ischemia. After failed and poorly tolerated enemas, urgent manual disimpaction under general anaesthesia with rectal saline lavage (around four litres) produced a massive evacuation estimated at ten kilograms. The early course was favourable: clinical improvement, no need for urinary diversion, recovery of kidney function to 62 mL/min/1.73 m², and ultrasound confirmation of decompression with reduction of renal pelvic diameters from 41 to 34 mm on the right and from 27 to 8 mm on the left. This case highlights the diagnostic and therapeutic value of CT and the effectiveness of prompt relief of distal obstruction in compressive fecalomas complicated by obstructive uropathy. Consent for publication was obtained; identity masked.