Stercoral obstructive colitis has non-specific physical and imaging findings, and it is often difficult to evaluate necrosis. This study aims to clarify the surgical indications and strategy for stercoral obstructive colitis. Subjects: Thirty cases of stercoral obstructive colitis were divided into two groups based on the presence or absence of necrosis. Vital signs, abdominal findings, CT findings, and blood gas findings were compared, and we investigated the predictors of necrosis. Additionally, in surgical cases, the surgical strategy was examined based on the frequency of necrosis progression and the association between CT findings and necrosis range. Results: There were no significant difference in the signs of peritoneal irritation or CT findings between the cases in the necrotic and non-necrotic groups. The shock index and lactate levels in the blood (8.3 vs. 3.8mmol/L, p<0.01) showed a significant difference, where the cut-off point of lactate was 5.8mmol/L (AUC 0.862, 95%CI 0.727-0.996). There were 18 surgical cases, out of which four had necrosis progression. The necrotic area was 84.6% consistent with the intestinal dilation area in the CT. Conclusion: It is difficult to detect colon necrosis in stercoral obstructive colitis from abdominal and CT findings. However, blood gas findings are useful. If the lactate level is 5.8mmol/L or higher, necrosis should be suspected, and an exploratory laparotomy is desirable. Dilated intestine has a high risk of necrosis, and if the dilation continues, it is desirable to confirm necrosis progression by planned re-operation.

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