CC BY-NC-ND 4.0 · Journal of Coloproctology 2015; 35(04): 223-226
DOI: 10.1016/j.jcol.2015.06.005
Case Report

A case of rectal stricture associated with the use of a fecal management system

Caso de constrição retal associada ao uso de um Sistema de manejo fecal
Kshitij Chatterjee
a  Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
,
Jagpal Singh Klair
a  Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
,
Abhishek Agarwal
a  Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
b  Division of Gastroenterology and Hepatology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
,
Farshad Aduli
a  Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
b  Division of Gastroenterology and Hepatology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, United States
› Author Affiliations

Abstract

Fecal management systems are widely used to prevent complications of fecal incontinence such as skin breakdown and pressure ulcers. However they are occasionally associated with complications such as bleeding and pressure necrosis of rectal mucosa. We present a patient with Clostridium difficile colitis with a prolonged hospital stay requiring the use of Flexi-Seal Fecal Management System who developed abdominal pain and distention with obstipation. Computed tomography of abdomen showed dilatation of small and large bowel loops with a transition point at rectosigmoid junction. Flexible sigmoidoscopy revealed the presence of a severe stricture at the rectosigmoid junction that was not amenable to endoscopic dilation. Surgical resection with an end-colostomy was performed to relieve the obstruction. To the best of our knowledge, this is the first reported case of a high-grade stricture due to use of bowel management system that needed bowel resection surgery.

Resumo

Sistemas de manejo fecal são amplamente utilizados com o objetivo de evitar as complicações da incontinência fecal, além de avarias à pele e úlceras de decúbito. No entanto, ocasionalmente esses sistemas estão associados a complicações, como sangramento e necrose por pressão da mucosa retal. Apresentamos um paciente com colite por Clostridium difficile com prolongada permanência no hospital e que necessitou do uso do Flexi-Seal Fecal Management System; esse paciente veio a sofrer dores e distensão abdominal, juntamente com obstipação. A tomografia computadorizada do abdome revelou dilatação de alças de intestine delgado e grosso, com um ponto de transição na junção retossigmóidea. A sigmoidoscopia flexível revelou presença de grande constrição na junção retossigmóidea, que não permitia dilatação endoscópica. Realizamos ressecção cirúrgica com colostomia terminal, com o objetivo de aliviar a obstrução. Até onde vai nosso conhecimento, este é o primeiro caso relatado de constrição de alto grau causada pelo uso de um sistema de manejo intestinal necessitando de cirurgia de ressecção intestinal.



Publication History

Received: 05 March 2015

Accepted: 08 June 2015

Publication Date:
17 February 2021 (online)

© 2015. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil