Fecal Impaction in the Rectum and Rectosigmoid Colon Secondary to Sunflower Seed Ingestion

A 35-month-old male who had eaten a bag of sunflower seeds initially presented to the emergency department (ED) with visible seeds in the anus and was discharged home with a stool softener after manual disimpaction. He then returned to the hospital 2 days later, and abdominal radiographs confirmed significant fecal material within the rectum and rectosigmoid colon. After failed oral and rectal laxative therapy attempts, subsequent disimpaction under anesthesia revealed an undigested sunflower seed bezoar in the rectum extending to the distal segment of his sigmoid colon. This case highlights the dangers and possible complications of seed ingestion even in small quantities in children along with the pathophysiology of impaction. This is one of the youngest cases reported in the United States involving the rectum and rectosigmoid colon with a sunflower bezoar.

The impact of an electronic medical record nudge on reducing testing for hospital-onset Clostridioides difficile infection

Objective:To determine the effect of an electronic medical record (EMR) nudge at reducing total and inappropriate orders testing for hospital-onset Clostridioides difficile infection (HO-CDI).Design:An interrupted time series analysis of HO-CDI orders 2 years before and 2 years after the implementation of an EMR intervention designed to reduce inappropriate HO-CDI testing. Orders for C. difficile testing were considered inappropriate if the patient had received a laxative or stool softener in the previous 24 hours.Setting:Four hospitals in an academic healthcare network.Patients:All patients with a C. difficile order after hospital day 3.Intervention:Orders for C. difficile testing in patients administered a laxative or stool softener in <24 hours triggered an EMR alert defaulting to cancellation of the order (“nudge”).Results:Of the 17,694 HO-CDI orders, 7% were inappropriate (8% prentervention vs 6% postintervention; P < .001). Monthly HO-CDI orders decreased by 21% postintervention (level-change rate ratio [RR], 0.79; 95% confidence interval [CI], 0.73–0.86), and the rate continued to decrease (postintervention trend change RR, 0.99; 95% CI, 0.98–1.00). The intervention was not associated with a level change in inappropriate HO-CDI orders (RR, 0.80; 95% CI, 0.61–1.05), but the postintervention inappropriate order rate decreased over time (RR, 0.95; 95% CI, 0.93–0.97).Conclusion:An EMR nudge to minimize inappropriate ordering for C. difficile was effective at reducing HO-CDI orders, and likely contributed to decreasing the inappropriate HO-CDI order rate after the intervention.

Complete Rectal Prolapse in Children: Case Report, Review of Literature, and Latest Trends in Management

BACKGROUND: Complete rectal prolapse is the circumferential descent of all the layers of the rectum through the anus. It often leads to bleeding, obstructed defecation, incarceration or fecal incontinence. CASE REPORT: We present a rare case of a 4-year-old child with complete rectal prolapse of 12 cm in length. The prolapsed rectum was manually repositioned after reducing the oedema. The precipitating factor was identified as excessive straining while passing stools. A change in position while passing stools was advised along with a high fibre diet and a stool softener. Recurrence was not observed in the 3 month of follow-up. CONCLUSION: Most cases of pediatric rectal prolapse are managed conservatively by addressing the associated and precipitating etiological factors. Surgical intervention may be required for recurrent or persistent cases.

Docusate and Sennosides for Constipation (DRAFT)

This chapter describes a prospective study that ran from December 2005 to November 2010 using three hospital inpatient units of adding a stool softener, docusate versus placebo, to sennosides alone for the treatment of constipation among hospice patients. Patients were adults admitted to an inpatient hospice program with a Palliative Performance Status 20% or greater. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.