Bidirectional endoscopic and pharmacological approach for the treatment of severe right-sided colonic stool impaction

A female patient in her 40s with scleroderma and Behçet's disease presented with dehydration, weight loss, fever and stool impaction. She failed aggressive laxatives and rectal enemas and was referred for colectomy. Abdominal X-ray revealed severe proximal colonic faecal impaction. We used a bidirectional approach to stimulate laxation composed of jejunal infusion of magnesium citrate using enteroscopy, gastrografin infusion into the right colon using colonoscopy, and intravenous neostigmine to stimulate peristalsis. This novel, three-pronged, outpatient approach using osmotic laxatives and peristaltic stimulants facilitated successful disimpaction over 36 hours, preventing possible colonic perforation or colectomy in a complex patient with right-sided stool impaction and comorbidities. This is a single case report that does not provide evidence for the safety or efficacy of a new treatment strategy.