Treatment Options for Faecolith (Stercoral) Obstruction of the Colon in Two Similar Cases

A woman and man in their 20s presented to the accident and emergency (A&E) department with abdominal pain, vomiting, and absolute constipation. They both presented as atypical candidates for faecal impaction with few medical and lifestyle risk factors. On CT imaging, a faecolith was visualised in the sigmoid colon as a cause of the large bowel obstruction (LBO) in both patients. A faecolith obstruction can be a life-threatening sequela of faecal impaction. The first line of treatment for LBO is conservative management with oral laxatives and enemas. If this is unsuccessful, interventions such as flexible sigmoidoscopy with the placement of enemas above the blockage can be used. In the event of a compromise to bowel vascularity or if previous interventions prove unsuccessful, there is also scope for surgery. After the resolution of the blockage, follow-up investigations should be performed to elicit an underlying cause in the hope of preventing a recurrence.