Urinary Obstruction Secondary to Fecal Impaction: An Unusual Presentation of Stercoral Colitis

Stercoral colitis is an inflammatory complication of prolonged fecal impaction, with presentations ranging from mild colonic inflammation to life-threatening perforation. Although gastrointestinal manifestations are well recognized, secondary involvement of adjacent pelvic structures due to mass effect remains underreported and may contribute to atypical clinical presentations. An elderly woman with paranoid schizophrenia receiving long-term antipsychotic therapy presented with a three-day history of lower abdominal pain, distension, and urinary retention. Although there was no documented history of recurrent constipation, bowel obstruction, or prior related hospital admissions, chronic subclinical constipation could not be excluded, given the background of prolonged antipsychotic use. Cross-sectional CT of the abdomen and pelvis demonstrated significant fecal impaction within the sigmoid colon and rectum, associated with bowel wall thickening and pericolonic fat stranding consistent with stercoral colitis. The fecaloma exerted marked extrinsic compression on the urinary bladder, resulting in bilateral hydronephrosis and hydroureter in the absence of intrinsic urological pathology, consistent with obstructive uropathy secondary to fecal impaction. This case highlights an uncommon but clinically important mechanism by which fecal impaction complicated by stercoral colitis may result in urinary tract obstruction. It emphasizes the importance of considering extrinsic compressive etiologies in the evaluation of urinary retention, particularly in patients with neuropsychiatric comorbidities and exposure to medications associated with impaired bowel motility. Early recognition and timely bowel decompression are critical for clinical resolution and may reduce the need for invasive urological intervention.