From the Research
The likelihood of obstruction for a 3.2 cm x 2.5 cm fecalith in the transverse colon of a 2-year-old male weighing 12.2 kg is high and requires immediate medical attention. This fecalith is significantly large relative to the child's colon diameter, which typically ranges from 1.5-2.5 cm at this age. Immediate intervention is recommended, likely requiring a combination of medical and possibly surgical management. Initial treatment should include IV fluid resuscitation, nasogastric tube decompression, and consultation with pediatric surgery. Medical disimpaction may be attempted using polyethylene glycol (PEG) solution at 1-1.5 g/kg/day divided into 4-6 doses, or enemas such as sodium phosphate (2-4 mL/kg) or mineral oil (5-15 mL/kg). However, given the size of this fecalith, endoscopic removal or surgical intervention may be necessary if medical management fails. The obstruction risk is particularly concerning because the transverse colon has less distensibility than the sigmoid or descending colon, and the child's small body size further increases the risk of complete obstruction, which could lead to perforation, peritonitis, or bowel ischemia if not addressed promptly. Ongoing monitoring for signs of complete obstruction including worsening abdominal pain, vomiting, abdominal distension, and absence of bowel movements is essential during management.
Key Considerations
- The size of the fecalith is a significant concern, as it is large relative to the child's colon diameter 1.
- The transverse colon has less distensibility than other parts of the colon, increasing the risk of obstruction 2.
- The child's small body size further increases the risk of complete obstruction, which could lead to serious complications such as perforation, peritonitis, or bowel ischemia 3.
- Medical management may be attempted, but surgical intervention may be necessary if medical management fails 4.
Management Options
- IV fluid resuscitation and nasogastric tube decompression to manage symptoms and prevent dehydration 5.
- Medical disimpaction using polyethylene glycol (PEG) solution or enemas such as sodium phosphate or mineral oil 3.
- Endoscopic removal or surgical intervention if medical management fails 1.
- Ongoing monitoring for signs of complete obstruction, including worsening abdominal pain, vomiting, abdominal distension, and absence of bowel movements 2.