Fekal impaksiyon ve fekalom

Özet

Fekal impaksiyon, özellikle kronik kabızlığı olan, hareket kısıtlılığı veya nörolojik hastalığı bulunan kişilerde sert dışkının kolonda ya da rektumda takılı kalmasıdır. BT, dışkı yükünün yerini ve tıkanma oluşturup oluşturmadığını gösterirken basit impaksiyon ile basınç kaynaklı stercoral inflamasyonu ayırmaya yardım eder. Fekaloma lümeni doldurabilir ve proksimal kolon genişlemesine yol açabilir; tek başına duvar kalınlaşması veya perikolik yağ reaksiyonu beklenmez. Komşu duvar hasarı fark edilmezse ülserasyon, iskemi ve perforasyon gelişebilir.

Faz ve pencere

Kontrastsız tanısal

Kontrastsız karın-pelvis BT'sinde rektum veya kolon lümenini dolduran, heterojen dışkı densitesindeki kitle; içinde küçük gaz cepleri ve proksimal dışkı-gaz birikimi izlenir. Basit impaksiyonda komşu kolon duvarı ince kalır ve perikolik yağda inflamatuvar kirlenme olmaz; kontrast fazı rutin tanı için gerekli değildir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Lümeni dolduran fekaloma — sert, heterojen dışkı materyali rektum veya kolon segmentini belirgin biçimde genişletir.
• Rektal ampulla distansiyonu — fekal yük çoğu kez rektum ve rektosigmoid bileşkede yoğunlaşır.
• Proksimal fekal yük — impaksiyonun üst tarafında dışkı ve gaz birikimi, geçişin kısıtlandığını gösterebilir.
• Basit impaksiyonda duvar korunumu — fekalomanın komşuluğundaki duvar kalınlaşmamış, perikolik yağ planları temizdir.
• Basınç etkisi — komşu mesane veya pelvik organlarda yer değiştirme ve bası görülebilir.
• Komplikasyon şüphesi — çevresel duvar kalınlaşması, yağ kirlenmesi, duvar içi gaz ya da ekstraluminal hava artık basit impaksiyonla sınırlı değildir.

Normalde

Lümen boyutu karşılaştırması — patolojik durumlarda rektum ve kolon belirgin şekilde genişler ve duvar kalınlaşır; normal dokuda bu patolojik distansiyon ve duvar değişimleri gözlenmez. BT'de fekal impaksiyon veya fekalomayı, kolon dilatasyonu, duvar kalınlaşması ve perikolik yağ kirlenmesi açısından birlikte değerlendirin.

Ayırıcı tanı

Stercoral kolit

fekalomaya ek olarak segmental duvar kalınlaşması ve perikolik yağ kirlenmesi bulunur.

Malign kitle

rektal veya kolon kanseri, obstrüksiyona neden olan fokal duvar kalınlaşması ve lümen daralmasının radyolojik bulguları ile görülür.

Mekanik obstrüksiyon

kolorektal kanser veya striktür gibi fokal lezyonlar geçiş noktası oluşturur; proksimal kolonda belirgin genişleme ve distalde lümen çapında azalma izlenebilir.

Kolon psödo-obstrüksiyonu (Ogilvie sendromu)

mekanik tıkanıklık olmaksızın kolonda belirgin gazla genişleme izlenir, yoğun fokal fekaloma ana bulgu değildir.

Rektal prolapsus

rektum duvarı anal kanaldan dışarı uzanır; lümen içi dışkı kalıbı oluşturmaz.

Tuzaklar

• Yaygın dışkı yükü ile basınca bağlı fekalomayı ayırt edin; lümeni tıkayan sert dışkı kitlesi komşu duvar damarlarını sıkıştırarak iskemi ve ülsere yol açabilir.
• Dışkı ve kitle ayrımı — CT'de heterojen dışkı materyalinin gerçek kitlelerden ayırt edilmesi önemlidir; duvar kalınlaşması veya ekstraluminal hava yoksa bulgu dışkı kaynaklıdır.
• Duvar çevresinde yağ kirlenmesi veya azalmış kontrastlanma varsa tanıyı basit impaksiyon olarak bırakmayın; stercoral inflamasyon ve iskemi yönünden tekrar gözden geçirin.

Kendini dene

1. Kronik kabızlığı olan hastada rektum lümenini sert dışkı dolduruyor, duvar ince ve çevre yağ planı temizse en uygun tanı hangisidir?

   • Fekal impaksiyon
   • Stercoral kolit
   • Rektal adenokarsinom
   • Sigmoid volvulus
   Cevabı göster

   Fekal impaksiyon. Lümen içi fekaloma, ancak duvar kalınlaşması ve yağ reaksiyonu olmaması basit fekal impaksiyonu destekler. Stercoral kolitte komşu inflamasyon; adenokarsinomda duvar kökenli yumuşak doku; volvulusta torsiyon ve kapalı ans aranır.

2. Dışkı kitlesinin çevresinde duvar kalınlaşması ve perirektal yağ bulanıklığı izlenirse hangi komplikasyon spektrumu akla gelmelidir?

   • Stercoral kolit
   • Rektal divertikül
   • Kolon lipomu
   • Akut apandisit
   Cevabı göster

   Stercoral kolit. Fekaloma çevresinde duvar ve yağ dokusu inflamasyonu stercoral kolit lehinedir. Diğer tanılar bu fekaloma merkezli duvar reaksiyonunu açıklamaz.

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 15 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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