SHM Converge Scientific Abstract ePoster Gallery-Mysterious Rectal Mass: A Migratory Tale

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This case report describes a 77-year-old man with Parkinson’s disease, neurogenic bladder, chronic constipation, and intermittent watery diarrhea who presented with recurrent left lower quadrant abdominal pain and no bowel movement for six days. CT imaging showed fecal retention, colitis, and a 9 cm lobulated rectal mass with a calcified rim, raising concern for rectal cancer, foreign body, or giant fecaloma. The patient had undergone daily self-catheterization, which initially increased suspicion for an inserted or ingested foreign body, though he denied this.<br /><br />A key finding was that comparison with CT scans from the prior six months showed the mass had migrated from the distal sigmoid colon to the upper rectum, supporting a fecaloma rather than malignancy. Because of persistent symptoms and concern for cancer, the patient eventually agreed to sigmoidoscopy. Endoscopy revealed a black fecal mass with egg-shell calcification, which was broken up using a water jet. Pathology confirmed stool material with calcium and barium salts in the rim, with no evidence of cancer.<br /><br />The report highlights that fecal impaction and fecalomas are common in elderly patients and those with neurological or functional bowel disorders. These masses can mimic colorectal cancer on imaging, especially when calcium or barium deposits create a radio-opaque rim. Complications may include bowel obstruction, bleeding, urinary retention, and hydronephrosis. The authors emphasize that timely direct visualization with sigmoidoscopy or colonoscopy can prevent unnecessary concern and reduce complications, and that conservative treatment such as enemas, laxatives, and manual disimpaction may be effective, with endoscopic or surgical options reserved for refractory cases.

Asset Subtitle

Syed Muhammad Hussain Zaidi

Meta Tag

Author List Aamir Makda, Apeksha Kakkar, Mashu Shrivastava, Preya Patel, Sarasija Natarajan, Syed Muhammad Hussain Zaidi, Udit Asija, Vikas Khurana

Category Clinical Vignettes

Concept Fecaloma

Concept Partial Colonic Obstruction

Concept Rectal Mass

Concept Colorectal Cancer

Concept Foreign Body

Distinguished Non-Finalist

Presenter Organization Wright Center for GME

Presenting Author Syed Muhammad Hussain Zaidi

Track Adult

Keywords

fecaloma

rectal mass

Parkinson’s disease

fecal impaction

colitis

sigmoidoscopy

computed tomography

calcified rim

bowel obstruction

manual disimpaction

Fecaloma

Partial Colonic Obstruction

Rectal Mass

Colorectal Cancer

Foreign Body