ROSH Gastrointestinal Practice Exam

In a patient with constipation and fecal seepage after recent rib fractures, what is the most likely diagnosis?

1. Colon cancer

2. Diverticulitis

3. Fecal impaction

4. Sigmoid volvulus

The correct answer is: Fecal impaction

In a patient with constipation and fecal seepage, especially following recent rib fractures, the most likely diagnosis is fecal impaction. This condition occurs when a large mass of stool becomes stuck in the colon or rectum and cannot be expelled. The history of rib fractures may suggest limited mobility or discomfort, possibly leading to decreased bowel activity and constipation. When constipation is severe, it can result in fecal impaction. This impaction can create pressure on the rectal walls, leading to a phenomenon known as "overflow incontinence," where liquid stool seeps around the impacted stool. The presence of seepage in conjunction with constipation is a hallmark sign of fecal impaction, making it the most plausible diagnosis in this scenario. Other conditions, such as colon cancer, diverticulitis, and sigmoid volvulus, may present with changes in bowel habits or abdominal pain but do not typically manifest with overflow seepage related to constipation in the same way. Fecal impaction specifically aligns with the symptom profile of the patient, particularly following an event that might limit their mobility and bowel function.