Giant Sigmoid Fecaloma Causing Complete Large Bowel Obstruction in a Patient With Intellectual Disability: A Case...

Fecaloma is a rare but clinically significant cause of large bowel obstruction, often associated with chronic constipation and underlying conditions affecting bowel motility. We report the case of a 50-year-old man with a history of intellectual disability who presented with a 10-day history of progressive abdominal pain, obstipation, abdominal distension, vomiting, and intolerance to oral intake. Physical examination revealed a distended abdomen with decreased bowel sounds and no signs of peritoneal irritation. Laboratory findings were unremarkable except for a mild elevation of lactate dehydrogenase (LDH). Contrast-enhanced computed tomography (CT) demonstrated marked colonic dilation with a heterogeneous intraluminal mass in the sigmoid colon, consistent with a fecaloma, causing complete large bowel obstruction without evidence of perforation or ischemia. Given the severity of the presentation and clinical deterioration, the patient underwent urgent exploratory laparotomy, confirming a large impacted fecaloma with significant proximal colonic dilation. A sigmoidectomy with end colostomy (Hartmann's procedure) was performed without complications. The postoperative course was favorable, with adequate stoma function and no evidence of infection or leakage. Histopathological analysis confirmed chronic mechanical obstruction with adaptive muscular hypertrophy and pressure-related mucosal changes, without malignancy. This case highlights the importance of considering fecaloma as a differential diagnosis in large bowel obstruction, particularly in vulnerable populations. In addition, it underscores the role of timely imaging and surgical intervention in preventing severe complications.