Large Bowel Obstruction Secondary to a Fecaloma in a Child With Cerebral Palsy

A nine-year-old wheelchair-bound female with cerebral palsy and intellectual disability secondary to trafficking protein particle complex subunit 9 (TRAPPC9) mutation presented to the family medicine clinic after not having passed stool for six days. There was a history of chronic constipation. Examination revealed high-pitched "tinkling" bowel sounds; therefore, a plain abdominal X-ray was ordered to rule out the possibility of intestinal obstruction, which showed a large fecaloma in the rectum with dilated bowel loops proximal to it, signifying obstruction. This was successfully treated with the administration of a rectal enema and confirmed by a post-enema radiograph. Although rare in children, a fecaloma should be considered a cause of bowel obstruction, especially where there is a history of chronic constipation. A plain abdominal X-ray can be useful in diagnosing a fecaloma in pediatric cases.