Clinical Analysis of Stercoral Perforation without Mortality

Abstract

Aims: This study was designed to review the clinical features of stercoral colonic perforation and to evaluate the appropriate intraoperative procedures and postoperative management to achieve the best surgical outcomes. Methods: Between January 2009 and December 2015, 12 patients with stercoral perforation confirmed surgically and pathologically were included in this study, and their medical records were reviewed retrospectively. Results: The enrolled patients included 2 men and 10 women; their mean age was 73.8 years. Abdomino-pelvic CT was an important diagnostic tool, which revealed fecalomas, extraluminal air and pericolic fat stranding in all patients. Hartmann's operation was performed in all patients, with a mean operation time of 239.3 min. Perforation site was in the left colon, mainly in the sigmoid colon. Intraoperative hypotension developed in 8 cases (66.7%). Postoperatively, all patients needed intensive care for 6.5 days and 6 patients needed the administration of inotropic agents for 3.0 days postoperatively. Disseminated intravascular coagulation developed in 10 cases (83.3%). There was no surgical mortality. Conclusion: Colorectal surgeons should be aware of the possibility of stercoral perforation, despite its rare incidence. Deep understanding of this potentially fatal disease by surgeons could reduce surgical mortality and improve postoperative outcomes.

Stercoral perforation requiring a total colectomy: a challenging and extreme case

“…The most common site of perforation is the sigmoid colon, as was seen in this case 1 . Distal colonic perforation appears to be more common due to a declining water content, relatively poor blood supply, narrow luminal diameter and high intraluminal pressure 2 . Surgery is the only reasonable treatment option for stercoral perforation and is dependent on the patient's clinical status and size of perforation.…”

A rare occurrence of road accident: Stercoral colonic perforation

“…The typical form is that of a perforation of a hollow organ creating a picture of acute peritonitis with defense or even abdominal contracture, a biological inflammatory syndrome and radiological pneumoperitoneum [7]. The frequency of less symptomatic and misleading forms, because the long history of chronic constipation can lead to neglecting complaints of abdominal pain, and the absence of radiological pneumoperitoneum often make a positive diagnosis very difficult [8]. Although the clinic was that of acute peritonitis, in our patient, the diagnosis of stercoral perforation of the colon was evoked preoperatively given the traumatic context.…”

“…Antibiotic therapy must be adapted to the result of intraoperative bacteriological samples. The most recommended procedure is a Hartmann procedure with drainage of the abdominal cavity [8,12]. Externalization on a rod of the perforated colon as an ostomy is possible, but a biopsy must be systematic in order to rule out other diagnoses, mainly that of neoplastic lesion.…”

“…Colonic resection removing the perforated colon associated with a colorectal anastomosis can be performed straight away with or without a stoma in case of low peritoneal contamination [8,12]. Depending on the extent of the lesions and the distension of the upstream colon, resection may be more extensive up to subtotal colectomy with ileorectal anastomosis.…”

“…In all cases, an abundant peritoneal toilet must be done. An intraoperative colonoscopy is recommended by some authors in the search for stercoral ulcerations so that colonic resection eliminates them [8,12].…”