Fecal impaction: a cause of isolated small bowel dilatation on abdominal radiographs

Objective: The purpose of this study was to assess the frequency of isolate d small bowel dilatation on abdominal radiographs in patients with colonic fecal impaction and also to elucidate the cause of this finding. Methods: A computerized search of radiology files revealed 515 patients with colonic fecal impaction on abdominal radiographs. The radiologic, reports described isolated small bowel dilatation not related to other known causes of ileus or obstruction in 18 (3.5%) of the 515 patients. The films were reviewed t o determine the distribution of fecal impaction and the degree and extent o f small bowel dilatation. In 16 cases, medical records were reviewed to det ermine the clinical presentation, treatment, and course. Finally, follow-up radiographs were reviewed in four cases to determine the response to treat ment of the impaction, Results: All 16 patients with available medical reco rds had abdominal symptoms. The average diameter of the dilated small bowel on abdominal radiographs was 3.7 cm. Fourteen patients (78%) had a diffuse colonic fecal impaction (nine) or a predominantly right-sided fecal impact ion (five) that involved the cecum, and the remaining four (22%) had a left -sided colonic fecal impaction. All 12 patients with clinical follow-up had resolution of symptoms and all four with follow-up radiographs had resolut ion of small bowel dilatation after treatment of the underlying impaction. Conclusion: Fecal impaction should be considered in the differential diagno sis of small bowel dilatation on abdominal radiographs, as treatment of the underlying impaction usually produces a dramatic clinical response with re solution of the small bowel dilatation on follow-up radiographs. (C) 2001 E lsevier Science Ireland Ltd. All rights reserved.