Fecal impaction is a common cause of colonic obstruction especially in elderly debilitated patients and in patients who have chronic illnesses. Occasionally hard fecoliths may lead to ulceration or perforation of the colonic wall. Colonic obstruction secondary to impaction of a large fecolith is rare. Most of the patients with fecolith are admitted to the emergency service with the signs of intestinal obstruction and they have generally history of chronic constipation. A 45 year old man presented to our emergency department with a 3 days history of intermittent, severe abdominal pain, bilious vomiting, constipation, and abdominal distention. Physical examination revealed abdominal tenderness in all quadrants, metallic bowell sounds and distention. The patient underwent an urgent laparotomy. The diagnosis was fecal impaction and the patient treated by removal of fecaliths and transverse colostomy procedure. Fecal impaction causing abdominal emergency should always be taken into account in the management of colonic obstruction.
Keywords: Fecolith, Colonic obstruction, Acute Abdomen