Giant Fecaloma Presenting as Acute Respiratory Distress in a Bedridden Elderly Patient: A Case Report

Fecal impaction is a common condition among elderly patients, particularly those who are bedridden or affected by neuropsychiatric disorders and chronic constipation.Although most cases present with GI symptoms, severe complications may occasionally occur.We report the case of a 77-year-old bedridden woman with a history of major depressive disorder who presented to the ED with acute respiratory distress.Clinical examination revealed tachypnea, cyanosis, and oxygen saturation of 80% on room air despite normal pulmonary auscultation.The abdomen was markedly distended.Chest radiography showed elevation of the right hemidiaphragm, and abdominopelvic CT revealed a giant rectocolic fecaloma measuring more than 26 cm, extending to the subhepatic region, with marked elevation of the right hemidiaphragm.Laboratory tests showed acute kidney injury with a prerenal profile and hemoconcentration, as well as hyperlactatemia with mild metabolic acidosis; intra-abdominal pressure was not measured.Common cardiopulmonary causes of dyspnea, including pulmonary embolism, pneumonia, and heart failure, were considered less likely given the normal pulmonary auscultation, normal electrocardiogram, and marked abdominal distension, prompting abdominal imaging.Manual disimpaction followed by evacuation enemas resulted in the removal of a large volume of stool, with rapid improvement in respiratory symptoms and progressive normalization of renal function over 10 days.This time course is consistent with, but does not prove, a causal relationship.This case highlights an unusual presentation of fecal impaction as acute respiratory distress, probably related to mechanical diaphragmatic elevation, with possible but unmeasured intra-abdominal hypertension.In frail or immobile older adults with otherwise unexplained dyspnea accompanied by marked abdominal distension and risk factors for constipation, severe fecal impaction may be considered among potential intra-abdominal causes after urgent cardiopulmonary conditions have been assessed.