Stercoral ulceration results from impaction of hard fecal mass on the colonic wall and is a relatively unknown cause of lower gastrointestinal bleeding. In this report, we describe a case of lower gastrointestinal bleeding due to stercoral ulceration resulting from Sevelamer, a drug which is commonly associated with constipation.

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This study assessed the effectiveness of two types of health plans, offered by the same health care provider, in the diagnosis and treatment of colorectal cancer. Data on 330 cases diagnosed from 1984 through 1989 were abstracted from medical records. Of these, 205 (62%) used fee‐for‐service (FFS) and 125 (38%) used health maintenance organization (HMO) plans. Overall, there were no differences between FFS and HMO cases for duration of symptoms before diagnosis, training of physician who diagnosed the tumor, anatomic location of the tumor, type of primary treatment, Dukes' stage at final diagnosis, or survival. There were differences between the groups for age, presence of symptoms at diagnosis, time from detection to treatment, and method of detection. Cox regression analysis showed no difference in survival by type of health plan before or after adjusting for age and stage at diagnosis. The findings from this study are consistent with those from studies reporting little or no difference in the process or outcome of care for patients with different types of medical insurance coverage. Cancer 1992; 692418‐2425.

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