title: Fecal impaction: a systematic review of its medical complications.
abstract: BACKGROUND
  Fecal impaction (FI) is a common problem in the elderly and other at-risk groups, such as patients with a neuro-psychiatric disease. It has been associated with medical problems and high morbi-mortality. A systematic review of this topic might be useful to improve the knowledge in this area and helpful to make an appropriate and early diagnosis.
  
  
  METHODS
  A PubMed systematic search was performed using relevant keywords. Case reports published in English, Spanish or French till June 2014 were included if they had a diagnosis of FI and a medical complication secondary to it. Each case was classified based on its principal complication. The main objective is to create a classification of FI complications based on published clinical cases.
  
  
  RESULTS
  188 articles met inclusion criteria, comprising 280 clinical cases. Out of the total, 43,5% were over 65 years old, 49% suffered from chronic constipation, 29% had an underlying neuropsychiatric disease and 15% were hospitalised or institutionalised. A total of 346 medical complications secondary to FI were collected. They were divided according to gastrointestinal tract involvement and then classified based on their anatomical and pathophysiological mechanism into three groups: Complications secondary to fecaloma effect on the intestinal wall (73.4%), on the intestinal lumen (14%) and on adjacent structures (12.6%).
  
  
  CONCLUSIONS
  FI causes complications that might be fatal. The elderly, underlying neuropsychiatric disease and hospitalised or institutionalised patients integrate the high-risk group in which FI must be suspected. The first FI complications classification is presented to improve the knowledge about this entity.
authors.affiliation: Gastroenterology Department, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain, 28040, Madrid, Spain. blan.serrano.falcon@gmail.com.
authors.forename: Blanca
authors.initials: B
authors.lastname: Serrano Falcón
authors.affiliation: Gastroenterology Department, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain, 28040, Madrid, Spain. marta.barcelo@yahoo.es.
authors.forename: Marta
authors.initials: M
authors.lastname: Barceló López
authors.affiliation: Gastroenterology Department, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain, 28040, Madrid, Spain. bmateosm85@gmail.com.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mateos Muñoz
authors.affiliation: Gastroenterology Department, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain, 28040, Madrid, Spain. angelalvarezsanchez@gmail.com.|Department of Medicine, Universidad Complutense de Madrid, Spain, Plaza Ramón y Cajal, 28040, Madrid, Spain. angelalvarezsanchez@gmail.com.
authors.forename: Angel
authors.initials: A
authors.lastname: Álvarez Sánchez
authors.affiliation: Gastroenterology Department, Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos (IdISSC), Madrid, Spain, 28040, Madrid, Spain. rey.enrique.spain@gmail.com.|Department of Medicine, Universidad Complutense de Madrid, Spain, Plaza Ramón y Cajal, 28040, Madrid, Spain. rey.enrique.spain@gmail.com.
authors.forename: Enrique
authors.initials: E
authors.lastname: Rey
mesh_terms: D000368:Aged; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005244:Fecal Impaction / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis