Developing Sigmoid Volvulus after Medical Disimpaction of a Patient with Stool Impaction: A Case Report

Stool impaction is an ailment resulted from chronic constipation which commonly found in the elderly population. It causes wide range of potential complications if not promptly diagnosed and treated. These complications doubled when elder people experience other co-morbidities. A case of an 80 years old lady with advanced dementia, bedridden and non-communicating is presented for clinical study. This patient who was presented with abdominal distention and changes in her mental status was found to have stool impaction based on the clinical and radiological test conducted to her. After ten days of proximal softening with distal washout therapy (using polyethylene glycol through PEG tube and lactulose enema), her condition deteriorated as her abdominal distention increased. An abdominal X-ray and CT scan showed the occurrence of sigmoid volvulus which wasn't there previously. She underwent decompression colonoscopy procedure successfully. The records, observations, and procedures conducted in this case recounts that proximal softening with distal washout therapy pushed the stool to the redundant sigmoid colon of this elder patient, resulting in twisting of the colon that caused sigmoid volvulus. The study also presents discussion about the complications of stool impaction, the complication of enemas, relevant published cases, and guidelines of palliative constipation management in the elderly population.