Death by fecaloma

Area of Science:

• Medical Examiner
• Forensic Pathology
• Pulmonary Medicine

Background:

• A 59-year-old male with pre-existing cerebral palsy and dextroscoliosis, requiring supplemental oxygen, died in a group home setting.
• The patient had a history of absent bowel movements for several weeks preceding his death.

Observation:

• Autopsy revealed a distended abdomen, leg flexion contractures, and significant fecal loading in the sigmoid colon and rectum.
• Postmortem CT imaging demonstrated a dilated digestive tract, rostrally displaced diaphragm, and severe scoliosis impacting thoracic cavity volume.

Findings:

• Internal examination confirmed a 2.5 kg fecaloma and rectal fecaliths, alongside severe scoliosis causing thoracic compromise.
• Microscopic analysis indicated chronic aspiration pneumonia and pulmonary hypertension.
• The combined factors of fecaloma, cerebral palsy, scoliosis, and aspiration pneumonia contributed to respiratory failure.

Implications:

• This case underscores the potentially fatal consequences of severe constipation and fecal impaction, particularly in individuals with underlying neurological and musculoskeletal conditions.
• Clinicopathological correlation identified fecaloma as the acute precipitating factor for respiratory failure.
• Effective management of bowel function is crucial for preventing severe complications in vulnerable patient populations.