Striped feces

Specialty: Gastrointestinal.

• Thin, ribbon-shaped stools
• flattened stools
• filiform depositions

Why it occurs

• Obstructive neoplasm of the left colon or rectum (stenosing colorectal adenocarcinoma that reduces the lumen of the fecal canal)
• Benign rectal stenosis secondary to chronic inflammatory bowel disease (ulcerative colitis), pelvic radiotherapy or previous surgical anastomoses
• Chronic hypertonic anal sphincter or anismus (paradoxical contraction of the puborectalis muscle during evacuation)
• Extrinsic compression of the rectum due to advanced gynecological neoplasms, infiltrating prostate cancer or retroperitoneal tumors
• Partially canalized giant fecaloma that deforms the fecal bolus as it passes peripherally through the impacted mass.

Initial workup

Complete colonoscopy with taking biopsies of any stenosis or suspicious lesion (priority diagnostic study) | CT of the abdomen and pelvis with intravenous contrast (to stage tumor masses or evaluate extrinsic compressions) | Meticulous rectal examination (allows assessment of low rectal masses or the tone of the anal sphincter) | Sigmoidoscopy if full colonoscopy is not initially feasible.

Standard management

• Osmotic laxatives — polyethylene glycol 17 g per day dissolved in plenty of water to maintain a soft and fluid consistency, avoiding fecal impaction proximal to the stricture
• Topical calcium channel blockers if associated with severe anal hypertonia due to concomitant fissure — diltiazem 2% gel applied intra-anally
• Systemic oncological treatment, radiotherapy or surgical resolution in case of confirmation of primary neoplastic pathology.