Fecal Impaction Causing Pelvic Venous Compression and Edema.
Chronic constipation is a common condition which may result in fecal impaction. A 13-year-old male with chronic constipation and encopresis presented with fecal impaction for three weeks. The impaction caused abdominal pain, distension, encopresis, and decreased oral intake. He was found in severe distress with non-pitting edema of his feet and ankles along with perineal edema. The pedal edema worsened after receiving a fluid bolus, so concern arose for venous compression or a thrombus. A Duplex Ultrasound demonstrated changes in the venous waveforms of the bilateral external iliac and common femoral veins without thrombosis. Manual disimpaction and polyethylene glycol 3350 with electrolytes resolved the pedal and perineal edema. Four months later, he had soft bowel movements without recurrence of the edema. A repeat Duplex Ultrasound was normal. We present a child in whom severe fecal impaction caused pelvic venous compression resulting in bilateral pedal and perineal edema.
Department of Pediatrics, Penn State Milton S Hershey Medical Center , PA, USA.
Sara
S
Naramore
Department of Vascular Surgery, Penn State Milton S Hershey Medical Center , PA, USA.
Faisal
F
Aziz
Division of Pediatric Gastroenterology, Penn State Milton S Hershey Medical Center , PA, USA.
Chandran Paul
CP
Alexander
Department of Radiology, Penn State Milton S Hershey Medical Center , PA, USA.
Sosamma
S
Methratta
Department of Surgery, Penn State Milton S Hershey Medical Center , PA, USA.
Robert
R
Cilley
Department of Surgery, Penn State Milton S Hershey Medical Center , PA, USA.
Dorothy
D
Rocourt
Pedal edema; constipation; duplex ultrasound; fecal impaction; polyethylene glycol 3350 with electrolytes