Fecaloma-Associated Sigmoid Colon Perforation: A Case Report

Fecaloma represents an uncommon yet potentially life-threatening consequence of long-standing constipation. It refers to a densely compacted fecal mass that may result in serious sequelae such as intestinal obstruction, compromised bowel perfusion, and perforation. We describe the case of a 68-year-old woman with known chronic constipation and chronic kidney disease who presented with sudden-onset abdominal pain, progressive distension, and clinical features suggestive of a systemic inflammatory response. Computed tomography (CT) demonstrated a sizable fecaloma within the sigmoid colon along with free intraperitoneal air, raising concern for colonic perforation. The patient underwent emergency exploratory laparotomy, which revealed a perforation of the sigmoid colon adjacent to the fecaloma, and a Hartmann's procedure was subsequently performed. The postoperative recovery was uncomplicated, and the patient was discharged in good clinical condition. This report underscores the need to maintain a high index of suspicion for stercoral perforation in elderly patients with chronic constipation who present with an acute abdomen. Prompt diagnosis and timely surgical management are essential, as delayed treatment is linked to significant morbidity and mortality. Heightened clinical awareness of this rare but severe condition may contribute to improved patient outcomes.