A Stercoral Sigmoid Ulcer Masquerading as Perforated Diverticulitis

Abstract

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Perforation in a patient with stercoral colitis and diverticulosis: who did it?

“…The clinical presentation of stercoral perforation and diverticulitis with or without perforation can be similar ( 1 – 4 , 11 ). Stercoral perforation of the sigmoid colon usually presents with features of diffuse peritonitis and pneumoperitoneum ( 4 ) but can present with localized peritonitis (17–20%) ( 1 , 2 ) and can masquerade as diverticulitis or diverticular perforation ( 5 ). Signs of hollow viscus perforation mandate urgent exploratory laparotomy regardless of the cause; however, identifying the cause of localized peritonitis guides appropriate management.…”

“…Diagnostic delay may result in perforation of the colon with peritonitis and septic shock ( 1 – 4 ). The primary differential diagnostic consideration is diverticulitis in a patient with left lower quadrant pain, and if there is right lower quadrant pain, it is appendicitis ( 5 , 6 ). Diverticular diseases and stercoral colitis share many pathological features ( 1 , 2 , 7 , 8 ), and they can coexist in a patient, thus, further complicating the diagnostic dilemma.…”