Massive fecaloma causing bilateral hydronephrosis and acute kidney injury: a case report and review of the literature.

Introduction and importance: Postrenal acute kidney injury is caused by urinary outflow obstruction either by urethral obstruction or bilateral ureteral obstruction. Fecal impaction was rarely reported to cause hydronephrosis or acute kidney injury. Case presentation: A 76-year-old woman presented with abdominal pain, severe constipation, and lethargy. CT scan showed a massive rectosigmoid fecaloma with changes consistent with stercoral colitis with bilateral hydroureteronephrosis due to the mass effect from the large fecaloma on the distal ureters. Creatinine had climbed to 1.7 mg/dL with electrolyte disturbances. On the sixth day of hospitalization the patient had perforation of the left colon requiring Hartmann's procedure. The hydronephrosis resolved after surgery with complete recovery from acute kidney injury as creatinine went back to baseline of 0.46 mg/dL. Clinical discussion: The literature described a few cases of fecalomas causing hydronephrosis due to compression of the urinary tract. The presence of a urinary tract infection in the presence of ureteral obstruction poses a risk of developing obstructive pyelonephritis thereby requiring urgent treatment of the cause. Conclusion: Most fecalomas can be cleared using conservative measures. However, recognition of the need of surgical intervention in timely manner is paramount to avoid complications including acute kidney injury and bowel perforation.