A giant 4 kg fecaloma leading to intestinal obstruction in an adult survivor of anorectal malformation: a case report

Intestinal obstruction due to a giant fecaloma is a rare clinical condition, characterized by a markedly hardened fecal mass that is more severe than a simple fecal impaction. We report a case of a 24-year-old female with a history of repaired anorectal malformation (ARM) during infancy who presented with the complaint of abdominal rigidity, progressive abdominal distention, and chronic constipation. The contrast-enhanced computed tomography of the abdomen showed a grossly dilated rectosigmoid region. During laparotomy, a giant fecaloma (4 kg) was found obstructing the descending colon. The distal sigmoid stump was closed, and a diversion transverse colostomy was created to allow the passage of stool. The postoperative period was uneventful, and she was discharged with a well-functioning stoma. This case highlights that exploratory laparotomy with enterotomy and fecaloma extraction with the creation of a diversion transverse colostomy can be an effective and safe treatment approach, leading to excellent postoperative recovery and symptom relief.