Case Report

Fecal Impaction and Systemic Inflammatory Response Syndrome in A Young Male with Cerebral Palsy

Authors: Ihab I. ElHajj, MD, Lara M. El-Zahabi, MD, Haitham Abdul-Baki, MD, Kassem A. Barada, MD

Abstract

Symptoms of fecal impaction extend from constipation, anorexia, nausea, vomiting and abdominal pain, to full blown sepsis. We present the case of a patient with cerebral palsy and mental retardation, who presented to the Emergency Department with a 3-day history of diffuse abdominal pain and fecal incontinence. Evaluation revealed severe fecal impaction. The patient developed systemic inflammatory response syndrome (SIRS), with negative workup for underlying etiology. He responded well to digital disimpaction and antibiotics. Our case illustrates the serious sequelae of fecal impaction, which should be considered in patients with neurologic disorders and SIRS.


Key Points


* Constipation and fecal impaction are common symptoms in patients with neurologic disorders (traumatic spinal cord injuries, spina bifida, multiple sclerosis, diabetic polyneuropathy, Parkinson’s disease, stroke, and cerebral palsy).


* Factors that may contribute to fecal impaction include impaired mental status, immobility, rectal hyposensitivity, weak straining, use of constipating drugs, and cerebral palsy.


* Symptoms of fecal impaction vary. They include abdominal pain, nausea, vomiting, anorexia, paradoxical diarrhea and incontinence, urinary problems of frequency, retention, and overflow incontinence.


* Fecal impaction can lead to systemic inflammatory response syndrome and in some cases to bacteremia.


* Treatment of fecal impaction include digital disimpaction, water enemas, and in some cases antibiotics.

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