P2044 - Fecal Impaction Caused by Bird Feed

Muhammad Umar Raza, MD, Nimra Shakeel, MD, Ikenna N Anaka, MD, Umair Iqbal, MD
WellSpan Health York Hospital, York, PA

Introduction: Undigested food material is an uncommon cause of fecal impaction which is often resistant to conservative management. We present here an unusual case of fecal impaction secondary to pigeon feed.

Case Description/Methods: A 71-year-old male with known Alzheimer’s dementia presented to the emergency department with complaints of abdominal pain and constipation. He had not had a bowel movement in 10 days. CT scan showed rectal wall thickening with fat stranding along with concerns for a large, unusual stoolball in the rectum as shown in Image A. He failed conservative management with laxatives. Manual disimpaction was attempted at the bedside but due to the patient’s extreme discomfort decision was made to perform manual disimpaction and possible flexible sigmoidoscopy under sedation. Manual disimpaction revealed undigested food material and flexible sigmoidoscopy revealed a large number of seeds impacted in the rectum which were manually disimpacted as shown in Image B. Rectal inflammation and ulceration were also demonstrated endoscopically after disimpaction as shown in Image C. There was a suspicion that patient may be eating birds’ food, and concerns were conveyed to the family. The family later confirmed they found a large amount of pigeon feed in the patient’s room. Following disimpaction, the patient had adequate bowel movements with a resolution of symptoms.

Discussion: Fecal impaction presents with symptoms of intestinal obstruction including abdominal pain, nausea, vomiting, and constipation with the inability to defecate. Untreated impaction can lead to severe intestinal obstruction and bowel perforation. It should be considered in patients with cognitive dysfunction, especially in the elderly. Fecal impaction has been previously reported with sunflower, pumpkin, pomegranate, date, lupin, lentil, sesame, mango, granadilla, and box myrtle seeds. It often leads to significant inflammation and ulceration of the gastrointestinal tract at the site of impaction. To our knowledge, this case is the first-ever report of fecal impaction from pigeon feed which is essentially a combination of sunflower, safflower, and hemp seeds mixed with dried corn, peas, barley, and other grains. Seed impaction typically does not respond to rectal enema and laxatives. Manual disimpaction and endoscopic evaluation should be performed under sedation if the patient has failed conservative management and is unable to tolerate bedside fecal disimpaction.



Disclosures:


Muhammad Umar Raza, MD, Nimra Shakeel, MD, Ikenna N Anaka, MD, Umair Iqbal, MD. P2044 - Fecal Impaction Caused by Bird Feed, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.