Fecal impaction remains a very under-recognized cause of hospital admission, typically occurring in the setting of a patient transferred from a nursing home.  A typical presentation would be in a nursing home patient with underlying dementia, who presents altered and dehydrated and is admitted for “rule out sepsis,” where workup to date in ER, including physical examination, blood work, chest x ray, urinalysis, ct brain, etc, have been unremarkable.  Fecal impaction would be much more common, than, say, meningitis, in this setting.  You will mostly likely find that a digital rectal exam has not been performed.  Performing a digital rectal exam in the ER, among other tests, should be among the essential workup performed with this presentation.  Fecal impaction, if severe enough, can sometimes present as urinary retention, another cause of the same presentation.  Unfortunately, anything goes in this patient population, including a patient who has fecal impaction coincidental to another serious diagnosis, but common things are common and fecal impaction should be considered high on the list with the above presentation, all else being equal.