Fecal Impaction: The Daily PANCE Blueprint

Home Fecal Impaction: The Daily PANCE Blueprint

Fecal Impaction: The Daily PANCE Blueprint

An 82-year-old male with a history of hypertension, Parkinson's disease, and type 2 diabetes is brought to the clinic due to abdominal pain x 1 week. He hasn’t had a bowel movement in a while. He is uncomfortable on exam. The abdomen is mildly tender to palpation, and there are hypoactive bowel sounds. DRE demonstrates hard stool. Which of the following is the best next step?

A. CTA abdomen/pelvis
B. Colonoscopy
C. Manual disimpaction
D. Exploratory laparotomy
E. High-fiber diet

Answer and topic summary

The answer is C. Manual disimpaction

Fecal impaction occurs when there is a mass of dry/hard stool that can’t pass out of the rectum. Clinical features include the inability to have a bowel movement for days/weeks, a distended abdomen, and possibly paradoxical diarrhea. A KUB should be obtained to rule out a possible bowel perforation. Management includes manual disimpaction, an osmotic enema (e.g., warm water or mineral oil), and potentially glycerin or bisacodyl suppositories.

View blueprint lesson

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Colorectal disorders ⇒ Fecal Impaction

Sign up for the ENTIRE Blueprint Daily Email Series (500 days and counting! 😀)

Sign Up
X