Dystocia Caused By Chronic Fecal Impaction

Dysfunctional labor resulting from fecal impac-tion is a rare occurrence.1-4 All of the previously published cases resulted in vaginal delivery after disimpaction. We repon the first case of obstruc-tion of labor secondary to massive chronic fecal impaction and megacolon that required Cesarean section. case Report The patient, a 19-year-old gravida 2 para 1, was admitted to our hospital on 31 October 1990. By history of last menstrual period she was 42 weeks' gestational age. She complained of the onset of labor pain 3 hours before admission to the hospi-tal. The patient's prenatal care consisted of two prenatal visits to an outlying health department. Her medical history revealed chronic constipa-tion since early childhood, requiring multiple hospitalizations, yet the patient and her family were unaware of a specific diagnosis or of any rec-ommendations for definitive treatment. Chronic constipation and fecal incontinence had persisted into adulthood. It was reponed that numerous physicians had attempted to perform pelvic ex-aminations and Papanicolaou smears but had been unable to do so because of her abnormal colon. The prenatal history also noted that the patient had been hospitalized in psychiatric hospitals, but again a specific diagnosis was not known. Review of the prenatal social history showed that she had at times been homeless during her pregnancy. She had smoked one pack of cigarettes per day during her pregnancy but denied use of alcohol or recreational drugs. The above history was confirmed by family mem-bers present at the time of hospitalization. They also reponed that the patient had a pro-found fear of physicians, which was confirmed by our observations