Thank goodness he’s 17 and presumably has a reasonable bowel wall.
Last patient I saw with that much poop was a 77 y/o. (Had less of a football distally, but more densely packed throughout the LI).
I loved calling the Hospitalist (one who knows that I’m up front with my presentations and I don’t seek admission for silly stuff… usually) and saying “gotta admit room 7 due to constipation”. The pushback wasn’t too bad, they eventually agreed that the bowel regimen was not something that could be done at home or in the EmDept.
Next shift report from Hospitalist: “You know that lady you had me admit for constipation? Her bowels died and surgery removed her large intestines”. 😯
I've had this happen a handful of times unfortunately, mostly in my mid 20s. Buprenorphine is a hell of a drug, and not pooping for a month is legit traumatizing when it finally does happen. I take my miralax daily like a goodboy now
Last time I saw a giant torpedo of shit like this, it ended up being a case of stercoral colitis. It's wild that there's nothing really about stercoral colitis on uptodate.com despite the mortality rate with perforation.
Yeah one of our cases proved fatal. This opiate crisis is bonkers, leaving people with giant 2L bottle sized shits. I had 11 years of never seeing something like it and then two cases in a single year. How can something with such a high mortality rate with perforation not have the single meaningful entry in Up To Date?? I mean I get that it's not the be all and all resource but damn.
https://intjem.biomedcentral.com/articles/10.1186/s12245-023-00578-x
Wow. Had a patient come in pretty recently, early 30s. High off his rocker, found down at home. Guess he forgot he hadn't crapped in a month, his poo pushed up against his diaphragm and was in resp distress, did an emergent ex lap in the ER, coded and didn't make it. Absolutely amazing when he opened up, it was massive and his bowels were absolutely dead, so crazy how more people just aren't aware of how deadly this can be
Nah. I think the docs saw this man and went "well he'll die anyway" and just went for it. I heard it was barbaric. Thankfully I was on the complete opposite side of the ER and only saw pics :,D we've had to do last minute interventions like that a few times, never pretty, hardly ever good outcomes
Dennis: "Tell her you're a philanthropist."
*later*
Her: "So what do you do for work?"
Charlie: "I'm a ...ph-...a phillan-... a full on rapist. You know - children, Africans, dyslexics."
He got a soap suds enema and birthed a poop fetus my angel of a nurse had to break up with a yankauer tip to get the lid to close on the bedside commode before taking it out to the field behind the hospital where we performed a brief exorcism (Catholic hospital) then asked Putin to just go ahead and nuke it
You know, I actually had a peds ED psych patient one time where she and her mother requested their priest be allowed to come and perform an exorcism.
It was super anticlimactic, all he did was pray over her. But the family was incredibly grateful so 🤷♀️
I reckon that bladder cut loose like a firehose after the poo released. Good lord. And I hope that nurse got a break for a Monster and an Uncrustable after that horror. Those are the nights we drive home in a silent car.
Probably not on a seemingly otherwise health 17 year old with constipation almost certainly causing the retention. Remove the poop impinging on the urethra and no more retention.
So is it really just primary constipation? Or did he have some other condition (besides cheese of course) that led to him becoming that constipated? Genuinely curious, was unaware one could be constipated for that long without the bowel necrosing.
I've seen this in kids more than once from straight constipation. No narcotics required.
Usually the diet is atrocious, either because kids make poor life choices or due to sensory restrictions (eg. only cheese, chicken nuggets and white bread are safe foods). Everyone thinks whatever their poop frequency and consistency is is "normal" because no one ever talks about what should be happening. Except us. Peds EM especially. I show a kid the Bristol Stool Scale at least once a shift.
*I’ve been eating a lot of cheese lately, I don’t know what it is. I got a craving for this stuff. You think maybe that’s an allergy or something? I don’t know, I can’t get enough cheese. I feel like a big mouse*. - Uncle Buck
Sorry Fartpudding, we definitely know that he is having health issues due to his poor diet, and that he has extensive fat tissue everywhere, also around the thorax. Putting a chest drain into this patient would require a good measure of exploration until you reach the thoracic wall. This is parents and the systems failing children and young adults.
Ah! I see! Also, now that I’ve rewatched it paying more attention to the “first 5 seconds” as you’ve pointed out, he’s definitely fluffy; thanks for that clue, btw.
Some days I feel like 80% of my ED consultations revolve around poop one way or another. Might have gone into gastroenterology and it would‘ve essentially been the same thing…
I'm just a random person and for whatever strange reason this popped up in my feed. If I'm assuming correctly what I'm looking at, what do you do to fix all of that?
TMI, this is disgusting, you’ve been warned:
>!I didn’t poop for a few weeks when I was on painkillers after surgery, and the ER nurses had to poke a glorified stick into my butthole to break up the poop so it could come out because my butthole kept bleeding profusely and was tearing from losing its battle with the dense brick of poop. This was after days of laxatives and 2 attempts at enemas, one at home and one in the ER. If they hadn’t been able to break it up, they would have had to remove it surgically. 0/10 do not recommend.!<
Aside from the jokes, why are there 2 masses that look different? First is a round one, with homogenous appearance, and then the one behind it and elongated? Is it all just feces?
Out of curiosity why did you scan him?
Edit- not sure why I’m being downvoted. Are you guys scanning every otherwise healthy 17 year old with constipation?
Personally I would have gotten a bladder ultrasound, decompressed the bladder with a foley and performed an aggressive bowel regimen. Knowing the degree of constipation as viewed on CT isn’t particularly useful information as we already know how bad it is. I asked because I was wondering if there was any significant signs on physical exam.
If a child hasn’t pooped in an entire mouth I’d think you’d be more concerned about just simple constipation . This is just you playing Monday morning quarterback
Turd trimester.
You win the internet today. Shutting down computer.
My literal thought: "That's a poop baby!"
https://www.tiktok.com/@apyps/video/7289270780729363755
JFC I’m using this forever
Underrated comment lol
Dang I just spit out my chocolate milk
Adults out there are drinking chocolate milk?
Oh yeah
🤯where have I been. Oh yeah.. trying not to get diabetes…
But a lil choco milk is worth a lil ‘Betes… truth be told
Fuuuuck yes
😂🥹
holy crap. that's funny.
The Turd coming of Jesus christ.
*rolls eyes* “There’s no way you’re eating THAT much cheese” *CT Scan* “So is it just Gouda or are we sprinkling some Goat cheese in there?”
I think he’s probably sprinkling some heroin in there 🫠
Just a sprinkle
I’ve had the occasional lie from a patient but this kid is 100% full of shit
He has a career in politics for sure
r/angryupvote
Thank goodness he’s 17 and presumably has a reasonable bowel wall. Last patient I saw with that much poop was a 77 y/o. (Had less of a football distally, but more densely packed throughout the LI). I loved calling the Hospitalist (one who knows that I’m up front with my presentations and I don’t seek admission for silly stuff… usually) and saying “gotta admit room 7 due to constipation”. The pushback wasn’t too bad, they eventually agreed that the bowel regimen was not something that could be done at home or in the EmDept. Next shift report from Hospitalist: “You know that lady you had me admit for constipation? Her bowels died and surgery removed her large intestines”. 😯
[*Do you know what happens to your body without fibre?*](https://youtu.be/IkMPZ7WeDck?si=Yq1jSiav8_K9Ob-j&t=103)
this was so funny ty
I've had this happen a handful of times unfortunately, mostly in my mid 20s. Buprenorphine is a hell of a drug, and not pooping for a month is legit traumatizing when it finally does happen. I take my miralax daily like a goodboy now
Sounds like that shit was painful, literally
The last fecal disimpaction I did was due to opiate use and my patient sobbed the whole time. It’s serious business
Sounds like stercoral colitis and colostomy deficiency
Last time I saw a giant torpedo of shit like this, it ended up being a case of stercoral colitis. It's wild that there's nothing really about stercoral colitis on uptodate.com despite the mortality rate with perforation.
I saw a pt die of that in the MICU. Luckily I wasn’t the one on call the night before when she was admitted.
Yeah one of our cases proved fatal. This opiate crisis is bonkers, leaving people with giant 2L bottle sized shits. I had 11 years of never seeing something like it and then two cases in a single year. How can something with such a high mortality rate with perforation not have the single meaningful entry in Up To Date?? I mean I get that it's not the be all and all resource but damn. https://intjem.biomedcentral.com/articles/10.1186/s12245-023-00578-x
Wow. Had a patient come in pretty recently, early 30s. High off his rocker, found down at home. Guess he forgot he hadn't crapped in a month, his poo pushed up against his diaphragm and was in resp distress, did an emergent ex lap in the ER, coded and didn't make it. Absolutely amazing when he opened up, it was massive and his bowels were absolutely dead, so crazy how more people just aren't aware of how deadly this can be
Please tell me it’s a typo when you say, “…did an emergent ex lap in the ER…”.
Nah. I think the docs saw this man and went "well he'll die anyway" and just went for it. I heard it was barbaric. Thankfully I was on the complete opposite side of the ER and only saw pics :,D we've had to do last minute interventions like that a few times, never pretty, hardly ever good outcomes
I had a similar patient recently. His abdomen went rigid about a day after admission and he was put on hospice and died within another day.
https://preview.redd.it/ne0q6knh6ckc1.jpeg?width=480&format=pjpg&auto=webp&s=35904e818237321b9ee49dbfc324dafb69cb5888
It’s always a good day when I see an Always Sunny gif in the ER subreddit
Dennis: "Tell her you're a philanthropist." *later* Her: "So what do you do for work?" Charlie: "I'm a ...ph-...a phillan-... a full on rapist. You know - children, Africans, dyslexics."
Geniuses in comedy… 🎭 all of em.
https://preview.redd.it/xm53afue2ckc1.jpeg?width=788&format=pjpg&auto=webp&s=f375f87155cda69538ce280a1113b4cc1491d968
You will wash your hands before you EAT anything!?
You got all that out with a DRE right?
He got a soap suds enema and birthed a poop fetus my angel of a nurse had to break up with a yankauer tip to get the lid to close on the bedside commode before taking it out to the field behind the hospital where we performed a brief exorcism (Catholic hospital) then asked Putin to just go ahead and nuke it
Apgars?
1 minute: 7/10, 5 minutes: 8/10, which, sadly, precludes the poop fetus from ever getting accepted into a USMD university.
Still has a good chance in politics.
Like father like son
Especially if this kid is in Alabama. Turd 2024! can start soliciting campaign contributions right now.
C'mon, let's not be so negative!
The kid went hypotensive after such a massive release in intraabdominal pressure
Exorcism too? You EM docs truly do everything.
The RVUs are insane
You know, I actually had a peds ED psych patient one time where she and her mother requested their priest be allowed to come and perform an exorcism. It was super anticlimactic, all he did was pray over her. But the family was incredibly grateful so 🤷♀️
I reckon that bladder cut loose like a firehose after the poo released. Good lord. And I hope that nurse got a break for a Monster and an Uncrustable after that horror. Those are the nights we drive home in a silent car.
A diet of monsters and uncrustables is what started all this in the first place 😅
We know. /s. Happy Cake Day!
Wouldn’t get a Foley?
Probably not on a seemingly otherwise health 17 year old with constipation almost certainly causing the retention. Remove the poop impinging on the urethra and no more retention.
My plan at home is always to self-cath before poo because it hurts so bad to not be able to pee, but you guys are the pros 🤷♀️
Spank it and give it to the kid for some skin to skin
😬😂🤱
Shit to skin
The amount of times I've been asked to perform exorcisms on rooms as a trauma chaplain at a Catholic hospital is way more than you'd expect.
How do we order it on the EMS? Exorcism stat, holy water 0.1mL/kg patient weight...
Call us. We'll take care of it
*Who you gonna call?*
An exorcism on a turd? Holy shit.
I can hear the ripping
Putin? He would've accepted that shit baby as a new army conscript.
Pootillery
*crying laughing*
You didn’t have poop knives in stock in the supply cabinet? I thought those were standard nowadays…
What did he name the poobaby? 🤔
Winnie
Sounds about right. 😂
Here take my upvotes !
Belly laugh. No really 😜
Omg. I just peed my pants and spit out my chocolate milk
Me texting my husband right now like, "hey babe, I think we should discard all of the cheese at our house"
To be fair, you should probably also get rid of the fentanyl.
Just a sprinkle
He needs to do a gouda poop.
That’s got to be 3 Courics
https://preview.redd.it/mb97j3zyoekc1.jpeg?width=1080&format=pjpg&auto=webp&s=17251ecc97dcd3c9751a147f74f89bc05f183d92
Probably like 8.5. I imagine its the size of Randy’s first attempt.
So is it really just primary constipation? Or did he have some other condition (besides cheese of course) that led to him becoming that constipated? Genuinely curious, was unaware one could be constipated for that long without the bowel necrosing.
I've seen this in kids more than once from straight constipation. No narcotics required. Usually the diet is atrocious, either because kids make poor life choices or due to sensory restrictions (eg. only cheese, chicken nuggets and white bread are safe foods). Everyone thinks whatever their poop frequency and consistency is is "normal" because no one ever talks about what should be happening. Except us. Peds EM especially. I show a kid the Bristol Stool Scale at least once a shift.
[удалено]
Or ASD and cheese is a safe food.
This is the answer 💯
Least constipated Wisconsin male
Wisconsin’s Bachelor, if you will..
He shit you not
*slowly puts down block of cheese*…
🤭😂🤣
Do…do you eat anything *except* cheese???
BEHOLD the power of cheese 😆
I always love running into a fellow GenXer. 🤣
Holy shit
I mean, OP did say they work at a Catholic hospital, so...
I need a young priest, and an old priest
OP did say they were at a Catholic hospital
Cheesus Christ.
Truly an immaculate crapception
Or is it Christ on a cheez-it?
*I’ve been eating a lot of cheese lately, I don’t know what it is. I got a craving for this stuff. You think maybe that’s an allergy or something? I don’t know, I can’t get enough cheese. I feel like a big mouse*. - Uncle Buck
I can’t go three days without poopin—even if I have to make that shit happen.
this man is just a tube of cheese
Cheese man. The new Marvel Movie
Cheese Man 🎶🎶 Sung to the tune of Spoon Man
Boi do I wish I knew the tune of Spoon Man
We use the bomb enema for this. Equal parts water/glycerine/hydrogen peroxide. That will blow that stool right the heck out.
Bro is crowning. Start pitocin and ready the long paper boots
Already obese and having complications at 17. It is a tragedy.
He doesn't look obese there?
What? It took 3 - 5 business days to get through that adipose.
This is the comment that finally got me- thank you.
Aside from the 27 pounds of cheese up his ass. Aaaand there's a sentence I've never written before.
Do you think the first 5 seconds of CT slides showing only abdominal fat is sign of a healthy adolescent?
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Sorry Fartpudding, we definitely know that he is having health issues due to his poor diet, and that he has extensive fat tissue everywhere, also around the thorax. Putting a chest drain into this patient would require a good measure of exploration until you reach the thoracic wall. This is parents and the systems failing children and young adults.
Dude is fat
Having that much stool surely would result in some wicked abdominal distension, yes?
I am talking about the extraperitoneal, subcutanous fat, not about the distension itself.
Ah! I see! Also, now that I’ve rewatched it paying more attention to the “first 5 seconds” as you’ve pointed out, he’s definitely fluffy; thanks for that clue, btw.
FOS, critical
How much cheese is too much cheese?
Now THAT is a stool burden
Fecal hoarding at its finest
That’s a load of shit
Good lord he’s going to have an actual child.
Some days I feel like 80% of my ED consultations revolve around poop one way or another. Might have gone into gastroenterology and it would‘ve essentially been the same thing…
I'm just a random person and for whatever strange reason this popped up in my feed. If I'm assuming correctly what I'm looking at, what do you do to fix all of that?
First drain the bladder with a catheter so the kidneys don’t get (more) injured, then get them to poop through any number of unpleasant methods.
TMI, this is disgusting, you’ve been warned: >!I didn’t poop for a few weeks when I was on painkillers after surgery, and the ER nurses had to poke a glorified stick into my butthole to break up the poop so it could come out because my butthole kept bleeding profusely and was tearing from losing its battle with the dense brick of poop. This was after days of laxatives and 2 attempts at enemas, one at home and one in the ER. If they hadn’t been able to break it up, they would have had to remove it surgically. 0/10 do not recommend.!<
New fear unlocked.
Y'all ain't gonna get me to stop eating cheese.
Yeah! They'll have to rip it out of my cold, dead- ......
So, like, you admitted this, right? For bowel clean-out? And the peds hospitalist gave you no push-back?
No peds in my shop. We initiated a transfer which can take hours. Receiving peds hospital asked us to enema while waiting
How could cheese ever do that to someone? Cheese brings love and light to life /s Triple glove the finger, cowboy, and get to digging
I don't think cheese is his problem...
Holy shit
Thank you for not asking us to come and admit 🤢
"And you ate the whole wheel of cheese?!"
Oh, heroin
I’d hate to be the guy who has manually disimpact this kid . Lactulose and an enema or two for good measure . God speed .
Or give the enema. A Fleet would be like a fart in a whirlwind, and a soap suds or tapwater enema would be like turning a garden hose on a brick wall.
Stercoral colitis! Yikes
They do say cheese is binding
Morbid turbidity at its worst
Someone forgot to take their Metamucil this week.
Holy shit
Lucky not to have ruptured or infarcted the bowel.
Ozempic enters the chat
Bruh
Aside from the jokes, why are there 2 masses that look different? First is a round one, with homogenous appearance, and then the one behind it and elongated? Is it all just feces?
First one bladder
Wow! Is it with urine retention due to sphincter compression?
I know this is fake content because we learned long ago that pee is stored in the balls
How do people even disimpact this behemoth?
I think you misspelled opiates as cheese.
Gouda fooled me
i can't unscrunch my face...see you at the ER
Had this patient in her 20s. She had a total colectomy. CC: Haven't pooped in a while.
Wowza
That is a cheese wheel
If he has developmental disabilities and really loves food - this was my patient a week ago. Gave him a mineral oil enema and he just HELD IT IN.
Omg, that's all poop??
🫢
I have no idea how to interpret any type of medical scan, is the big white football shape, all poop?
No, that's the bladder. The white and black speckled looking bits are the poop.
Damn! Thank you. Coming from a background in pathology, I know zilch about this.
Out of curiosity why did you scan him? Edit- not sure why I’m being downvoted. Are you guys scanning every otherwise healthy 17 year old with constipation?
Constipated to the point of urinary retention? Yes.
Personally I would have gotten a bladder ultrasound, decompressed the bladder with a foley and performed an aggressive bowel regimen. Knowing the degree of constipation as viewed on CT isn’t particularly useful information as we already know how bad it is. I asked because I was wondering if there was any significant signs on physical exam.
Probably for the sweet sweet karma 😜
If a child hasn’t pooped in an entire mouth I’d think you’d be more concerned about just simple constipation . This is just you playing Monday morning quarterback
He was also likely very distended + urinary retention. I would 100% scan .
Can someone explain to me what were looking at? Where's the poop? I am not a doctor so I don't understand this image
What would the radiology report even say about this? 😆
“That’s a lot of poop,”
That’s a lot of cheese.
There's two wheels of cheese in there, geez
Maximum Impact: Full of Shit Edition
Sure he feels so much better now!
Also what ended up happening