EpistemisFecaloid vomiting
Specialty: Gastrointestinal.
Why it occurs
- Low mechanical intestinal obstruction (colon or distal ileum) secondary to postsurgical flanges, incarcerated hernias or stenosing colorectal adenocarcinoma
- Severe paralytic ileus due to diffuse peritonitis, severe hypokalemia, abdominal sepsis or complicated postoperative period
- Gastrocolonic fistula (pathological communication between stomach and colon secondary to gastric/colonic adenocarcinoma or perforated Crohn's disease)
- Mesenteric ischemia with necrosis and gangrene of intestinal loops that completely stops transit.
Initial workup
CT of the abdomen with emergency intravenous contrast (study of absolute choice to locate the level and cause of the obstruction or fistula) | Plain x-ray of the abdomen in standing and recumbent positions (presence of stair-level air-fluid levels, intestinal wall edema or pneumoperitoneum) | Emergency analysis: complete blood count (leukocytosis with shift to the left), arterial or venous blood gases with lactate (marker of intestinal ischemia), serum electrolytes and kidney function | Immediate placement of a nasogastric tube (NGT) for gastric decompression, measuring the output and appearance of the contents.
red flags
Signs of septic or hypovolemic shock (arterial hypotension, extreme tachycardia, oliguria, distal coldness and confusion), signs of diffuse peritonitis (plank abdomen, involuntary muscular defense), severe cellular dehydration and absolute cessation of the expulsion of gases and feces.
Standard management
- Aggressive parenteral hydration — Lactated Ringer's solution or 0.9% intravenous saline to correct volume depletion and restore hydroelectrolyte balance immediately
- Central action antiemetics — ondansetron 4-8 mg intravenously every 8 hours, although its efficacy is very limited without mechanical decompression due to concomitant NGT
- Empirical broad-spectrum antibiotic therapy — piperacillin/tazobactam 4.5 g IV every 6 hours, or combination of ceftriaxone 2 g IV every 24 hours plus metronidazole 500 mg IV every 8 hours if there is a high risk of bacterial translocation
- Controlled intravenous analgesia (metamizole 1-2 g IV or low-dose fentanyl under strict surgical supervision to avoid masking an acute abdomen).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gastrointestinal
- Listed causes
- 4
- Treatment options
- 4