The Backup That Led to a Blackout: Syncope and Severe Constipation

Syncope is a common presentation in the emergency department (ED); however, it is rarely due to stercoral proctocolitis causing inferior vena cava (IVC) compression. We describe the case of a young male patient who presented to the ED after having a syncopal episode. Through obtaining a detailed history and physical exam, he was found to have abdominal distention and endorsed constipation. He was diagnosed with severe fecal impaction causing stercoral proctocolitis and IVC compression causing intermittent syncope. He underwent an emergent exam under anesthesia and fecal disimpaction in the operating room. This case emphasizes the importance of doing a thorough physical exam to avoid missing a complication of this rare diagnosis.