A man almost died after his bowel became so full with feces it burst and caused his organs to start shutting down.
The 24-year-old was taken to the hospital after suffering with tummy pain and diarrhea for a week.
The patient, who is autistic, had a history of chronic constipation and had been admitted to the hospital a number of times over the last four years.
Examination showed he had a tender, swollen abdomen with minimal bowel sounds.
A CT-scan revealed he had a megarectum - a condition which causes the colon to dilate.
His rectum had dilated up to 18-cm inside his body and was "filled with feces", according to the BMJ case report.
He was given oral laxatives but refused regular enemas to clear his bowels.
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Two days later he returned to Newham University Hospital in London suffering inflammation in the stomach and reduced consciousness.
Further tests revealed his blood was becoming too acidic and his kidneys were starting to fail.
A second CT-scan found a "substantial perforation" of his bowel and he was rushed into surgery where doctors were able to close the tear.
The operation was successful and the man made a full recovery after being kept in intensive care.
"This patient had chronic, idiopathic megacolon and megarectum," Dr. Alexandros Apostolopoulos, who treated the man, wrote in the report. "Patients with this condition report recurrent episodes of constipation, abdominal pain, distension and bloating starting in childhood or adolescence."
"Due to increased intraluminal [gastrointestinal] pressures, these patients are at an increased risk of ulceration of the bowel wall," Apostolopoulos wrote. "Hence, they are at an increased risk of perforation."
Megacolon and megarectum are often treated with enemas and oral laxatives.
If these methods fail, surgery may be needed to correct the bowel to prevent serious complications.