Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 4 2026 04 18 181 184 Maryam Soheilipour Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Hoda Imani Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Elham Tabesh Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 11 21 2025 12 17 Fecal impaction is a frequent complication in elderly and neuropsychiatric populations, often due to multifactorial causes such as impaired motility, medication side effects, and behavioral abnormalities. In rare instances, ingestion of indigestible material, such as date pits, can lead to obstructive fecal loading. We report a 54-year-old woman with bipolar disorder and schizophrenia who presented with abdominal pain and constipation lasting three days. Laboratory findings were unremarkable, except for an elevated ESR. Imaging studies, including plain abdominal radiographs and abdominal ultrasound, showed no clear signs of obstruction but revealed colonic fecal loading. A CT scan without contrast demonstrated marked colonic dilatation and multiple hyperdense intraluminal foreign bodies, consistent with date pits. Upon questioning, the patient confirmed excessive ingestion of whole dates. Conservative management with enemas led to successful resolution, and the patient passed stool containing numerous intact date pits. Unusual causes of fecal impaction should be considered in at-risk populations, particularly psychiatric patients with erratic dietary behaviors. Recognizing the CT signature of ingested date pits is essential for accurate diagnosis and timely, conservative management. https://crcp.tums.ac.ir/index.php/crcp/article/view/1145 https://crcp.tums.ac.ir/index.php/crcp/article/download/1145/742