Vomiting that smells like feces is an alarming symptom. It indicates a significant underlying issue within the digestive system and requires immediate medical attention.
Understanding Feculent Vomiting
The medical term for vomit that smells like feces is feculent vomiting, also known as stercoraceous vomiting or copremesis. This occurs when intestinal contents reflux backward into the stomach and are then expelled. The distinct fecal odor arises because material that should be moving forward through the digestive tract is instead moving in reverse, signifying a disruption in normal waste passage.
Common Medical Causes
Several medical conditions can lead to feculent vomiting. Bowel obstruction is the most common and serious cause, occurring when a blockage prevents the normal passage of stool and gas through the intestines. This blockage can be mechanical, such as from scar tissue (adhesions) after surgery, hernias, tumors, or even gallstones. Alternatively, a paralytic ileus, where the intestinal muscles become paralyzed and cannot function properly, can also cause a backup of contents.
A less common but direct cause is a gastrocolic fistula, which is an abnormal connection between the stomach and the colon. This rare passage allows fecal matter to enter the stomach directly, leading to feculent vomiting. This rare condition can result from inflammatory reactions or malignancies.
Severe cases of gastroparesis, a condition where the stomach empties food too slowly, can also contribute to this symptom. When stomach emptying is significantly delayed, bacterial overgrowth and fermentation can occur, producing a foul, sometimes fecal-like odor in the vomitus. The extreme delay and bacterial activity can create a similar smell. Furthermore, severe constipation or fecal impaction, where hard, dry stool becomes stuck in the rectum or colon, can in rare instances lead to a pseudo-obstruction scenario. This extreme backup of contents can result in the expulsion of material with a fecal odor.
Accompanying Symptoms and Urgency
Feculent vomiting is rarely an isolated symptom and often presents with other signs of a serious underlying condition. Individuals may experience severe abdominal pain or cramping, which can come in waves. Abdominal distension or bloating is also common as gas and contents build up behind a blockage. An inability to pass gas or stool is a significant indicator of intestinal obstruction.
Dehydration, characterized by symptoms like a dry mouth and decreased urination, can rapidly develop due to persistent vomiting. Fever and a rapid heart rate may also be present, signaling infection or inflammation. In some cases, signs of shock, such as low blood pressure and cool, clammy skin, might occur. Vomit that smells like poop is always a medical emergency. Seek immediate medical attention by calling emergency services or going to the nearest emergency room, as waiting or attempting home remedies can lead to life-threatening complications.
What to Expect at the Hospital
Upon arrival at the hospital, medical professionals will conduct a thorough evaluation to determine the cause of feculent vomiting. This typically begins with a physical examination and a review of the patient’s medical history. Diagnostic tests identify the underlying problem. Imaging studies, such as X-rays or CT scans of the abdomen, are commonly performed to visualize the digestive tract and pinpoint any obstructions or abnormalities. Blood tests will also be conducted to check for signs of infection, electrolyte imbalances, or other systemic issues.
Initial management focuses on stabilizing the patient. Intravenous (IV) fluids will be administered to address dehydration and electrolyte imbalances. Patients will be made “NPO” (nil per os), meaning they will not be allowed anything by mouth, to rest the digestive system. A nasogastric (NG) tube may be inserted through the nose and into the stomach to decompress the stomach, removing built-up fluids and gas and relieving pressure. The specific treatment will depend on the diagnosed underlying cause, ranging from conservative management to surgical intervention, such as removing a blockage or repairing a fistula.