Presentation
Three months of constipation. Sense of lower abdominal/rectal fullness with passage of small amounts of hard stool.
Patient Data
The rectum and distal sigmoid colon are distended by the injected barium with a proximal sigmoid colon (mostly intraluminal) mass with a rounded edge obstructing the flow of barium to descending colon. The mass wasn't dislodged by changing to a decubitus position or rotating the patient.
The sigmoid mass observed on the barium study is seen in the CT study to be an intraluminal globular mass with a finely corregated surface and internal low density (fat) foci. The proximal bowel is collapsed with no evidence of intestinal obstruction.
The previously seen intraluminal sigmoid mass is still seen in today's study with the barium reaching the proximal sigmoid colon, confirming the non-obstructing nature of the lesion.
Case Discussion
Taking into consideration the patient's complaint of prolonged constipation and absence of psychiatric illness, this mass is mostly a fecaloma/impacted fecal matter causing constipation.