Dr. Raman Garg Successfully Treats an Extremely Rare Giant Sigmoid Faecolith Presenting as a Large Abdominal Mass Using a Minimally Invasive Approach
Chronic constipation is a common gastrointestinal disorder, but the formation of a giant sigmoid faecolith (faecaloma) large enough to mimic an abdominal tumour is exceptionally rare. Such cases may present with abdominal pain, a palpable abdominal lump, bowel obstruction, and diagnostic uncertainty, often requiring surgical intervention.
Dr. Raman Garg, Senior Surgical Gastroenterologist, Colorectal Surgeon, GI Cancer Surgeon, Hepatobiliary & Pancreatic (HPB) Surgeon, and Advanced Laparoscopic Surgeon, successfully managed this rare condition using a laparoscopic-assisted sigmoid colectomy, enabling rapid recovery through a minimally invasive approach.
Patient Presentation
A young female with a long-standing history of chronic constipation presented to Dr. Raman Garg with progressive abdominal pain, a large palpable abdominal lump, persistent constipation, and increasing abdominal discomfort.
Preoperative imaging suggested either a large benign abdominal tumour or a giant wide-mouthed sigmoid diverticulum filled with faecal material. Despite detailed evaluation, the exact diagnosis remained uncertain, and surgical exploration was planned.
Advanced Minimally Invasive Colorectal Surgery by Dr. Raman Garg
Following thorough assessment, Dr. Raman Garg performed laparoscopic-assisted colorectal surgery.
The procedure included laparoscopic mobilisation of the sigmoid colon, mobilisation of the ascending colon, mobilisation of the splenic flexure, delivery of the bowel through a 5 cm mini-laparotomy, and extracorporeal sigmoid colectomy with primary colorectal anastomosis.
This hybrid minimally invasive approach combined the benefits of laparoscopy with the safety of extracorporeal bowel reconstruction, resulting in minimal surgical trauma and faster recovery.
The surgery was successfully performed by Dr. Raman Garg at Bombay Gastro & Cancer Institute, Bathinda.
Unexpected Intraoperative Finding
On opening the resected specimen, the presumed abdominal tumour was found to be a giant impacted sigmoid faecolith (faecaloma) occupying the lumen of the sigmoid colon.
The massive faecolith had developed due to long-standing chronic constipation and had produced a large abdominal mass, closely mimicking a tumour on preoperative imaging.
Excellent Postoperative Recovery
The patient recovered uneventfully:
- Early return of bowel function.
- Gradual progression to a normal oral diet.
- No postoperative complications.
- Discharged in satisfactory condition on the 5th postoperative day.
Why This Case Is Important
A giant sigmoid faecolith is an exceptionally rare condition and is seldom encountered in modern colorectal surgical practice. Large faecoliths may mimic abdominal tumours, pelvic masses, giant colonic diverticula, and colorectal neoplasms.
This case demonstrates:
- Successful management of an extremely rare giant sigmoid faecolith.
- Accurate intraoperative diagnosis despite misleading imaging.
- Advanced laparoscopic-assisted colorectal surgery.
- Small-incision bowel resection with primary anastomosis.
- Excellent postoperative recovery with minimal surgical trauma.
This rare case highlights the importance of considering unusual causes of abdominal masses in patients with longstanding constipation and demonstrates the advanced colorectal surgical expertise of Dr. Raman Garg in managing complex gastrointestinal disorders.
Consultant Surgeon: Dr. Raman Garg
Patient: Young Female
Diagnosis: Giant Impacted Sigmoid Faecolith (Faecaloma) with Chronic Constipation, Mimicking an Abdominal Tumour
Procedure Performed: Laparoscopic Mobilisation of Sigmoid Colon, Ascending Colon and Splenic Flexure, with Extracorporeal Sigmoid Colectomy and Primary Colorectal Anastomosis through a 5 cm Mini-Laparotomy
Outcome: Uneventful recovery; discharged on the 5th postoperative day following successful laparoscopic-assisted colorectal surgery.
About Dr. Raman Garg
Dr. Raman Garg is a leading Surgical Gastroenterologist, Colorectal Surgeon, GI Cancer Surgeon, Hepatobiliary & Pancreatic (HPB) Surgeon, and Advanced Laparoscopic Surgeon based in Bathinda, Punjab. He specialises in the management of complex colorectal diseases, chronic constipation requiring surgery, intestinal obstruction, inflammatory bowel disease, gastrointestinal cancers, liver and pancreatic disorders, hernias, and advanced minimally invasive gastrointestinal surgery.
At Bombay Gastro & Cancer Institute, Bathinda, Dr. Raman Garg routinely manages rare and technically challenging gastrointestinal conditions that often require highly specialised surgical expertise.
Patient identity has been withheld to maintain confidentiality. This case is published solely for educational purposes and with due respect for patient privacy.
