BMJ Case Reports 2018; doi:10.1136/bcr-2018-224811
  • Rare disease

Large bowel obstruction in a 27-year-old woman caused by a sigmoid faecal bolus

  1. Robert Bethune
  1. Colorectal Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
  1. Correspondence to Mr Radford Arran James Smith, radford.smith{at}
  • Accepted 29 April 2018
  • Published 14 May 2018


A 27-year-old woman presented to the emergency department with a 24-hour history of severe left iliac fossa pain associated with vomiting. She reported a history of ovarian cysts and was provisionally diagnosed with a ruptured ovarian cyst and admitted under the obstetrics and gynaecology team for further investigation. 24 hours later, she became haemodynamically unstable with increasing abdominal distention and developed a metabolic acidosis. A CT scan revealed large bowel obstruction (LBO) secondary to a faecal bolus in the sigmoid colon with appearances suggestive of adult-onset Hirschsprung’s disease. She underwent an emergency laparotomy and decompressive transverse colotomy and was admitted to the intensive care unit overnight. After discharge, she presented again with small bowel obstruction (SBO) which resolved with conservative management. A follow-up colonoscopy and biopsies showed no anatomical abnormalities to account for the LBO and were inconclusive for Hirschsprung’s disease.


  • Contributors RAJS selected the case, designed and wrote the case report including a literature review. MA provided support and feedback on the first draft. RB provided supervision in the process and approved the final draft of the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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