ROSH Gastrointestinal Practice Exam

What is the next best step in managing fecal impaction in a patient with a complete C5 spinal cord injury?

1. Balloon tamponade with a Sengstaken-Blakemore device

2. Colonoscopy

3. Enema washout

4. Phrenic nerve stimulation

The correct answer is: Enema washout

In the management of fecal impaction, especially in a patient with a complete C5 spinal cord injury, the most effective initial strategy is to use an enema washout. This technique helps to soften and facilitate the passage of the impacted stool by introducing fluid into the rectum, which can effectively soften the fecal mass and promote evacuation. This is particularly important for individuals with spinal cord injuries due to reduced mobility and altered bowel function, which can lead to constipation and subsequent impaction. Enemas can be more rapidly initiated in a clinical setting and do not require the invasive measures that other options might involve. It is a straightforward approach that can often provide immediate relief of symptoms associated with fecal impaction, making it suitable as the next best step in management for this situation. The other options may not be appropriate as initial interventions. For instance, a Sengstaken-Blakemore device is typically used for managing esophageal variceal hemorrhage, which does not apply to fecal impaction. Colonoscopy, while it can address fecal impaction, is generally reserved for cases where other methods have failed or when there’s a need to assess for underlying conditions. Phrenic nerve stimulation is not relevant in this context, as