# A Case Report of Undiagnosed Chronic Constipation With Considerable Stool Burden

## TL;DR

A 25-year-old woman with severe chronic constipation avoided surgery through medical treatment and manual disimpaction, highlighting an alternative to standard care.

## Contribution

This case report presents a rare instance of successful non-surgical management of extreme stool burden in chronic constipation.

## Key findings

- Manual disimpaction under anesthesia successfully evacuated stool up to the distal sigmoid colon.
- The patient improved with medical treatment and a bowel regimen without requiring surgery.
- The case suggests surgery may be deferred if non-surgical interventions lead to improvement.

## Abstract

Chronic constipation is a prevalent issue in the United States that a majority of people have experienced at some time, with a variety of severity. Sometimes, people can become constipated for prolonged periods for various reasons. This is detrimental to one's health because the stool can build up in the colon and harden, creating obstipation. A 25-year-old female with an extensive history of chronic constipation and a history of hospitalization requiring medical management presented to the hospital with a chief complaint of minimal passage of stool over the last four months. Her vitals and labs were within normal limits. However, on physical exam, her abdomen felt like clay. A computed tomography (CT) scan showed a significant stool burden. The patient declined total colectomy with end ileostomy. She went for manual disimpaction under anesthesia, where they were able to evacuate stool up to the distal sigmoid colon. Following the procedure, the patient adhered to a pure liquid diet and a bowel regimen. Over time, the patient improved and was discharged on Miralax twice daily, with instructions to follow up with Gastroenterology and Colorectal Surgery for further monitoring. However, the patient did not follow up. A stool burden of this caliber is rarely seen. In this rare case, the patient resumed her everyday life with only medical treatment and endoscopy, offering a commentary on the current standard of care. Indeed, removing the aganglionic segment is the ultimate solution. However, surgery could potentially wait if the patient improves in this manner.