{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:40:04Z","timestamp":1756323604710,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,4,11]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>A female patient in her 40s with scleroderma and Beh\u00e7et\u2019s disease presented with dehydration, weight loss, fever and stool impaction. She failed aggressive laxatives and rectal enemas and was referred for colectomy. Abdominal X-ray revealed severe proximal colonic faecal impaction. We used a bidirectional approach to stimulate laxation composed of jejunal infusion of magnesium citrate using enteroscopy, gastrografin infusion into the right colon using colonoscopy, and intravenous neostigmine to stimulate peristalsis. This novel, three-pronged, outpatient approach using osmotic laxatives and peristaltic stimulants facilitated successful disimpaction over 36 hours, preventing possible colonic perforation or colectomy in a complex patient with right-sided stool impaction and comorbidities. This is a single case report that does not provide evidence for the safety or efficacy of a new treatment strategy.<\/jats:p>","DOI":"10.1136\/bcr-2024-263383","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T01:05:19Z","timestamp":1745975119000},"page":"e263383","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Bidirectional endoscopic and pharmacological approach for the treatment of severe right-sided colonic stool impaction"],"prefix":"10.1136","volume":"18","author":[{"given":"Raguraj","family":"Chandradevan","sequence":"first","affiliation":[{"name":"Gastroenterology\/Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Handley","sequence":"additional","affiliation":[{"name":"Anesthesiology, Medical College of Georgia, Augusta University, Augusta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satish","family":"Rao","sequence":"additional","affiliation":[{"name":"Gastroenterology\/Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"2025082712213967000_18.4.e263383.1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.2147\/CIA.S8100","article-title":"Update on the management of constipation in the elderly: new treatment options","volume":"5","author":"Rao","year":"2010","journal-title":"Clin Interv Aging"},{"key":"2025082712213967000_18.4.e263383.2","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1111\/apt.18170","article-title":"Review article: advances in the diagnosis and management of anorectal motility disorders","volume":"60","author":"Shahsavari","year":"2024","journal-title":"Aliment Pharmacol Ther"},{"key":"2025082712213967000_18.4.e263383.3","doi-asserted-by":"crossref","unstructured":"Malcolm A , Rao SSC . Chapter 22 - anorectal disorders: fecal impaction, structural disorders of the pelvic floor and anorectal pain syndromes. In: Rao SSC , Parkman HP , McCallum RW , eds. Handbook of gastrointestinal motility and disorders of gut-brain interactions. 2nd edn. 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