It is possible to vomit material that strongly resembles and smells like feces, a serious medical condition known as feculent vomiting, or sometimes stercoraceous vomiting. This occurrence is a definitive sign of a severe gastrointestinal problem that demands immediate emergency medical intervention. Feculent vomiting is a dire symptom of a complete or near-complete obstruction within the intestines. This signals a mechanical failure in the digestive tract that prevents the normal downward movement of contents.
Understanding Feculent Vomiting
Feculent vomiting occurs when the contents of the lower small intestine or upper colon are forced backward up the digestive tract. This material is not typically formed stool from the large intestine, but rather highly concentrated intestinal fluid and partially digested food. The characteristic fecal odor and appearance result from the massive proliferation of bacteria that normally reside in the lower gut. These bacteria colonize the stagnant contents above the obstruction, leading to fermentation and the production of gases and breakdown products.
The physiological process involves strong, uncoordinated muscle contractions known as reverse peristalsis. Peristalsis is the normal, wave-like movement that propels contents forward; in obstruction, the muscles contract vigorously to overcome the blockage, pushing contents in the wrong direction. These retrograde waves eventually force the material through the pyloric sphincter, which separates the stomach and the small intestine, allowing it to be expelled through the mouth. This mechanism indicates a blockage that has persisted for a significant period, occurring after the stomach and upper small intestine have been emptied.
Underlying Conditions That Cause Blockage
The most frequent cause of the complete intestinal obstruction that leads to feculent vomiting in adults is the presence of abdominal adhesions. These are bands of scar tissue, often forming after previous abdominal or pelvic surgeries, which can constrict or twist the small intestine. Adhesions are responsible for an estimated 60 to 70 percent of all small bowel obstructions, making them the most common culprit.
Other mechanical causes involve structural issues where a portion of the intestine is physically trapped or narrowed. Hernias, for example, can trap a section of the bowel outside the abdominal cavity, leading to strangulation and obstruction. Tumors, such as those arising from colon cancer, represent another significant cause, as a growing mass can compress or block the intestinal lumen.
Inflammatory conditions also contribute to blockages, with diseases like Crohn’s disease or diverticulitis causing chronic inflammation and subsequent strictures within the intestinal wall. Other severe obstructions include a twisting of the intestine on itself, known as volvulus, or the telescoping of one part of the intestine into another, called intussusception. A less common but serious cause is a pseudo-obstruction, or paralytic ileus, where the intestines fail to move contents due to nerve or muscle dysfunction.
When to Seek Emergency Medical Care
Feculent vomiting is a definitive sign of a life-threatening intestinal obstruction that necessitates immediate hospitalization and emergency care. The blockage can lead to severe complications, including a lack of blood supply to the affected bowel tissue, which can cause tissue death and ultimately perforation. A rupture of the intestinal wall allows bacteria to spill into the abdominal cavity, triggering a potentially fatal infection known as peritonitis.
Patients experiencing this symptom will also present with severe, crampy abdominal pain that often comes and goes in waves. This pain is frequently accompanied by significant abdominal distention, or swelling, as gas and fluids accumulate above the blockage site. The inability to pass gas or have a bowel movement is another hallmark symptom, confirming the complete mechanical failure of the digestive system.
Upon arrival at the hospital, the clinical pathway focuses on stabilizing the patient and resolving the obstruction. Immediate treatment involves placing a nasogastric (NG) tube through the nose into the stomach to suction out backed-up fluids and gas. This decompression relieves pressure on the intestinal wall, helping prevent further damage and reducing the risk of aspiration pneumonia. Intravenous (IV) fluids and electrolytes are administered rapidly to correct the severe dehydration and chemical imbalances caused by continuous vomiting.
Diagnosis is confirmed using imaging tests, most commonly X-rays and computed tomography (CT) scans, which locate the site of the obstruction and often indicate its underlying cause. While partial obstructions may sometimes be managed non-surgically, a complete obstruction, especially one presenting with feculent vomiting, most often requires surgical intervention. The goal of surgery is to physically remove the blockage, whether it is an adhesion, a tumor, or a section of compromised bowel, thereby restoring normal intestinal flow.