Proximal sigmoid fecaloma after stapled hemorrhoidopexy: a diagnostic pitfall and stepwise nonoperative management

Stapled hemorrhoidopexy (SH) is used for prolapsing hemorrhoids and is associated with less short-term postoperative pain. While constipation is common after SH, proximal sigmoid fecaloma is rarely reported. We report a 49-year-old woman who presented with severe abdominal pain and obstipation 14 days after SH. Although digital rectal examination revealed an empty rectum, computed tomography (CT) demonstrated a large fecaloma in the proximal sigmoid colon, 15 cm proximal to the intact staple line. A rectal tube enema failed, but a targeted high enema via flexible sigmoidoscopy achieved partial softening, followed by successful evacuation with nasogastric polyethylene glycol irrigation. This case highlights that an empty rectum on digital examination does not exclude proximal fecal impaction after SH. Early CT may help differentiate proximal fecaloma from staple-line complications and support stepwise nonoperative management in selected stable patients.