A fatal faecaloma stercoral colitis: a rare complication of chronic constipation

Abstract

DESCRIPTIONAn 80-year-old woman with type 2 diabetes and hypertension was admitted to hospital with lethargy and confusion. A collateral history revealed she suffered from chronic constipation and had not opened her bowels 'for a few days'. On examination, she was in urinary retention. A catheter was inserted and she was started on treatment for a urinary tract infection.Subsequently, the patient became tachycardic and hypotensive. Abdominal examination revealed generalised tenderness and hard faecal matter per rectum. Blood tests showed raised inflammatory markers with C reactive protein of 298 mg/L and a white cell count of 18.3×10 9 /L. CT of the abdomen and pelvis showed marked rectosigmoid faecal impaction, compression of the urinary bladder (figure 1) and inflammatory changes in the wall of the rectum and lower sigmoid, consistent with a diagnosis of stercoral colitis (figures 2 and 3). The patient was treated with enemas and intravenous antibiotics; despite this, she continued to deteriorate and, given the high operative risk, was deemed unsuitable for surgery and subsequently died.Stercoral colitis is an uncommon but important complication of chronic constipation. A faecaloma forms, causing distension of the colonic lumen, which decreases the blood supply to the area, 1 causing a colitis that can progress to ulceration and perforation. A CT scan often shows the classical appearance of a thickened rectum impacted with faeces, dilation of the sigmoid colon and fat stranding of the adjacent bowel.

Impacted faecaloma as first presentation of Crohn's disease

“…Highest risk groups include elderly patients and nursing home residents; however, the formation of a faecaloma can be secondary to opiates, obstructing lesions, immobilisation and neurological or functional bowel disorders 2 . Described complications can include bowel obstruction, bleeding, compressive hydronephrosis, stercoral colitis and perforation 3–6 . Diagnosis of faecal impaction and faecalomas can often be made based on abdominal X‐ray, but CT is useful to confirm the diagnosis and assess for complications.…”

Constipation Requiring Surgical Treatment in a Premenopausal Woman

“…She required surgical treatment because of constipation with abdominal pain despite no colon obstruction. Constipation is a common occurrence and can be occasionally fatal (1,2). Physicians should take care when dealing with patients with chronic constipation to avoid serious conditions.…”

Stercoral Ulcer and Colonic Perforation in an Individual with Parkinson's Disease with Constipation

“…To the Editor : Stercoral ulcer and colonic perforation are gastrointestinal emergencies because peritonitis inevitably ensues . We recently had a case of stercoral ulcer and colonic perforation in an elderly woman with Parkinson's disease (PD) who had long had constipation.…”

“…Stercoral (stool, fecal) ulcer is a rare gastrointestinal and surgical emergency, first reported in 1894; 35% mortality has been reported. It is considered a pressure ulcer in the colon or rectum caused by obstruction (impaction), high intraluminal pressure, and focal ischemia, all from the conglomerated, dehydrated stool in situ.…”

“…This condition is reported to occur in elderly adults with chronic constipation (particularly nursing home residents), neurologically impaired individuals (details not available), and in individuals taking certain medications (opiates, tricyclic antidepressants, tranquilizers), al of which can slow colonic transit . If not treated, ulceration leads to perforation, which appears at the sigmoid colon in 77% and is in multiple places in 27% of cases . Stercoral ulcer and colonic perforation have not been recognized in individuals with PD, although constipation, slow colonic transit, and anorectal abnormality are common in individuals PD, primarily due to neuronal loss and Lewy bodies in the myenteric plexus, which may occur earlier than motor disorder in PD .…”