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Death by fecaloma

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Abstract

A 59-year-old man with a history of cerebral palsy and dextroscoliosis died in a group home. He required supplemental oxygen and had no bowel movement for weeks prior to death. At autopsy, the abdomen was markedly distended and there were flexion contractures of the legs. Postmortem computed tomography revealed a dilated digestive tract and fecal loading in the sigmoid and rectum, marked upwardly displaced diaphragm and scoliosis. On internal examination, the diaphragm was displaced rostrally and the rectosigmoid colon contained 2.5 kg of fecaloma with two rectal fecaliths. Severe scoliosis with marked reduction in volume of thoracic cavity was present. Microscopic examination revealed chronic aspiration pneumonia and chronic pulmonary hypertension. Overall, four factors led to respiratory failure: fecaloma; cerebral palsy; scoliosis; and chronic aspiration pneumonia. Based on clinicopathological correlation, the cause of death was determined to be a combination of these factors, and the key acute factor was the fecaloma.

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Acknowledgements

The authors thank Dr. Toby Rose and Ms. Effie Waldie (Ontario Forensic Pathology Service) for assisting with manuscript preparation.

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Authors and Affiliations

  1. Provincial Forensic Pathology Unit, Ontario Forensic Pathology Service, Forensic Services and Coroners Complex, 25 Morton Shulman Avenue, Toronto, ON, M3M 0B1, Canada

    Yosuke Usumoto & Michael S. Pollanen

  2. Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King’s College Circle, 6th Floor, Toronto, ON, M5S 1A8, Canada

    Yosuke Usumoto & Michael S. Pollanen

  3. Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9, Kanazawa-ku, Yokohama-shi, Kanagawa-ken, Fukuura, 236-0004, Japan

    Yosuke Usumoto

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  1. Yosuke Usumoto
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  2. Michael S. Pollanen
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Correspondence to Yosuke Usumoto.

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Usumoto, Y., Pollanen, M.S. Death by fecaloma. Forensic Sci Med Pathol 18, 201–204 (2022). https://doi.org/10.1007/s12024-021-00438-1

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