Colonoscopic laxative instillation for the fecal loaded colon: A Case Series

Abstract Context: Post-operative, critically ill, and elderly patients often have fecal loading or impaction. In a few such patients, disimpaction of fecalomas and colon cleansing is difficult. Bowel obstruction, megacolon, lower gastrointestinal bleeding, and gut perforation are complications that may ensue. Oral laxatives or enemas may only be partially effective. Surgical intervention may be needed for salvage or for complications. Series and Design: Fourteen hospitalized cases with defecation disorder due to fecal loading of the colon were enrolled for retrospective analysis. Colonoscopic instillation of mannitol and /or lactulose was undertaken as an intervention when the use of oral laxatives was either ineffective or unfeasible, and enema too had yielded poor results. Results Ten patients had satisfactory outcomes for feal clearance, whereas four patients with poor or incomplete responses underwent repeat interventions or surgery. No significant complications were encountered due to this therapy. Conclusion Colonoscopic instillation of mannitol or lactulose in fecal loaded critically ill patients, results in a safe and satisfactory fecal clearance.