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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 59-year old man, institutionalized with depressive and nutritional disorders due to gastrostomy, was admitted to the nephrology office for renal function impairment that started a year ago, which coincided with an episode of urinary retention that required catheterization. The catheter was subsequently withdrawn after the symptoms resolved. During the current check-up, the patient presented obvious signs of dehydration with a worsening glomerular filtration rate: creatinine, 4.24<span class="elsevierStyleHsp" style=""></span>mg/dL; urea 307<span class="elsevierStyleHsp" style=""></span>mg/dL; Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI), 14.3<span class="elsevierStyleHsp" style=""></span>mL/min; sodium, 157<span class="elsevierStyleHsp" style=""></span>mEq/L; and potassium, 5.1<span class="elsevierStyleHsp" style=""></span>mEq/L. The ultrasound revealed grade 3 bilateral ureterohydronephrosis; the patient was therefore referred to the urology department for an urgent evaluation. The emergency department performed abdominal computed tomography, which revealed a giant fecaloma in the rectosigmoid (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), which caused extrinsic ureteral compression (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), resulting in acute renal failure due to obstruction. The patient underwent conservative management with serotherapy, laxatives and enemas, as well as manual disimpaction, which resulting in abundant stools and improvement of the symptoms and associated parameters.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Although extremely rare, fecal impaction should be considered in the differential diagnosis of acute obstructive renal failure, taking special care with elderly patients, patients with diabetes, those with psychiatric disorders and those polymedicated with opioids, antidepressants, anticholinergics or antipsychotic agents. Most cases involve banal conditions that are resolved with conservative treatment, although they occasionally constitute a medical–surgical emergency.</p></span>"
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