39 Case referred to by Guttmann (Physical Diagnosis, Sydenham ed., p. 360), in which the sound was dull tympanitic over two large fecal tumors which weighed when removed at the post-mortem six kilogrammes (sixteen pounds).
Fecal tumors40 are preceded by habitual constipation, and are most common in elderly people; they are changed in position and size or made to disappear by cathartics or rectal injections. Persistent treatment will bring away scybalæ which by their color and consistence show that they have long been in the canal. But the free movement of the bowels and the non-disappearance of the tumors are no proof that they are not fecal.
40 Tumeurs stercorales, Paris, Thèsis No. 240, 1878.
Fecal accumulations have been mistaken for ovarian tumors,41 cancerous tumors of the mesentery, uterine fibroids, and retro-uterine hæmatocele. Fecal tumors in the transverse colon have been taken for enlargement of the liver and spleen. In one instance obstruction of the bowel from fecal impaction was supposed to be a strangulated gut in a patient suffering from hernia: an operation was performed, the patient dying in sixteen hours afterward.42 Ovarian tumors in their early stages are sometimes thought to be fecal.43
41 Jas. Y. Simpson, Med. Times and Gazette, London, 1859, vol. ii. p. 549.
42 Thomas Bryant, Med. Times and Gazette, London, vol. i., 1872, p. 303.
43 J. B. Brown, Lancet, London, 1850, vol. ii. p. 48.
Fecal impaction in the rectum, with ulceration and bloody and mucous stools, may for a time be called cancerous ulceration. Sacculated scybalæ cannot be distinguished from submucous tumors even by the hand pressing on them in the rectum.44
44 H. R. Storer, Gynæcological Journ., 1869, vol. i. p. 80.
The history of each individual case, a full knowledge of etiological factors, and a careful physical examination will in most instances lead to a proper diagnosis.