Vomiting feces, medically known as feculent emesis, is possible and signals a severe, life-threatening medical emergency. This rare occurrence indicates that the normal digestive process has been completely disrupted. The symptom is almost exclusively associated with a total or near-total intestinal blockage. This extreme form of vomiting requires immediate emergency medical attention, as the body is attempting to expel contents by reversing the typical direction of digestive flow.
Understanding Feculent Emesis
Feculent emesis, or stercoraceous vomiting, describes the expulsion of material with a fecal odor and appearance. This vomitus is not solid stool from the large intestine. Instead, it consists of digestive contents backed up in the lower small intestine for an extended period.
The foul odor and dark appearance result from massive bacterial overgrowth within these stagnant contents. Normally, the small intestine has a low concentration of bacteria. A prolonged blockage allows bacteria to multiply and ferment the trapped contents, creating compounds that give the vomitus its fecal-like quality and smell. This indicates severe intestinal stasis rather than the simple reverse movement of formed feces.
The Physiological Roadblock
The mechanism behind feculent emesis is overwhelming pressure caused by a complete intestinal obstruction. Normally, the digestive tract moves contents forward via peristalsis, a wave-like muscular action. These contractions move material from the stomach through the intestines and out of the body.
When an obstruction occurs, gas, fluid, and partially digested food accumulate behind the blockage. The small intestine attempts to push the material past the obstruction, leading to intense, forceful spasms as the bowel muscles strain against the closed segment.
As pressure builds excessively above the obstruction, it overpowers the normal muscular valves that prevent backward flow. This sustained, high-pressure environment forces the backed-up contents in the wrong direction, known as reverse peristalsis. The material travels backward up the small intestine, through the pyloric sphincter into the stomach, and is expelled through the mouth.
Conditions That Lead to Blockage
Feculent emesis is caused by a complete mechanical intestinal obstruction, most commonly affecting the small bowel. The majority of these blockages result from adhesions, which are scar tissues forming after prior abdominal or pelvic surgery. These fibrous bands can tether or kink the intestine, physically preventing the passage of contents.
Another frequent cause is a hernia, where an intestinal segment protrudes through a weakened abdominal wall area. If the herniated segment becomes pinched or incarcerated, the blood supply can be compromised, leading to a rapid and complete blockage. Malignant tumors, originating in the bowel or spreading from other organs, can also compress or close off the intestinal lumen.
Less common causes include volvulus, which is the twisting of an intestinal loop around itself. Intussusception, where one segment of the bowel telescopes into an adjacent segment, is also a risk. Additionally, severe inflammation from conditions like Crohn’s disease can form strictures, or narrowings, that become impassable barriers.
Immediate Medical Intervention
Feculent emesis demands immediate emergency intervention due to the life-threatening crisis it represents. Medical professionals first prioritize stabilizing the patient and managing dehydration and electrolyte imbalances caused by persistent vomiting. Diagnostic imaging, such as an abdominal X-ray or CT scan, is quickly performed to confirm the location and nature of the obstruction.
A nasogastric (NG) tube is inserted through the nose into the stomach for decompression. This procedure suctions out backed-up fluid and gas, immediately relieving dangerous pressure on the intestinal wall and reducing the risk of rupture. These initial steps are supportive but do not resolve the underlying physical blockage.
Definitive treatment often requires surgical intervention to physically remove the obstruction. For blockages caused by adhesions, adhesiolysis is performed to cut the scar tissue and free the bowel. Surgery is also necessary to repair a hernia, remove a tumor, or correct a twisted segment (volvulus). Early diagnosis and prompt surgical correction are necessary to prevent complications like tissue death (ischemia) and intestinal perforation.