Giant mass in a 15-year-old girl

Gastroenterology and Hepatology From Bed to Bench, 2021 · DOI: · Published: June 21, 2021

Gastroenterology Pediatrics Research Methodology & Design

Simple Explanation

A 15-year-old girl was referred to a gastroenterology clinic due to fecal incontinence and constipation issues since childhood. Physical examination revealed a large mass in her abdomen. Further tests confirmed the presence of a giant fecaloma due to chronic functional constipation. The patient's parents initially declined a costly treatment option. Instead, they were instructed on how to administer lactulose enemas at home. This less expensive method proved effective in evacuating the fecaloma. After treatment, the patient's condition improved. She experienced more regular bowel movements and returned to school. While psychological and physiotherapy counseling was recommended, the parents reported they did not seek these additional treatments.

Study Duration

2 years

Participants

One 15-year-old girl

Evidence Level

Level 4, Case Report

Key Findings

1
The patient was diagnosed with a giant fecaloma due to chronic functional constipation, a condition where stool is withheld, leading to a large mass of impacted feces.
2
Lactulose enemas, administered by the patient's parents at home, proved to be an effective and less expensive method for evacuating the fecaloma.
3
After treatment with lactulose enemas, the patient's abdominal mass disappeared, and she experienced improved bowel movements and overall well-being.

Research Summary

This case report describes a 15-year-old girl with a giant fecaloma resulting from chronic functional constipation and stool withholding behavior. The patient presented with fecal incontinence, weight loss, and a palpable abdominal mass. Diagnosis involved physical examination, imaging studies (barium enema and CT scan), and anorectal manometry to rule out other causes of constipation. The patient was successfully treated with lactulose enemas administered at home after declining a more expensive pulsed irrigation evacuation (PIE) method. The case highlights the importance of early diagnosis and treatment of constipation, as well as the potential complications of fecalomas, such as intestinal obstruction and compression of adjacent structures. Psychological counseling and behavioral therapy are recommended alongside conservative treatments to address stool withholding behavior.

Practical Implications

Early Intervention

Early diagnosis and treatment of constipation are crucial to prevent the development of fecalomas and associated complications.

Conservative Management

Lactulose enemas can be an effective and less expensive alternative for fecaloma evacuation, particularly when more advanced methods are not feasible.

Behavioral Therapy

Addressing stool withholding behavior through psychological counseling and behavioral therapy is essential for long-term management of chronic constipation.

Study Limitations

1
The study is limited to a single case report, which restricts the generalizability of the findings.
2
The patient did not adhere to all recommended treatments (psychological and physiotherapy counseling), potentially impacting long-term outcomes.
3
The effectiveness of lactulose enemas may vary depending on the severity and characteristics of the fecaloma.

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