Pelvic Rectal Stercoral Perforation Resulting in Diffuse Pneumatosis

Abstract

An 83-year-old woman with oral corticosteroid use for chronic autoimmune conditions presented with abdominal pain and constipation for the previous seven days. CT of the abdomen and pelvis revealed a large fecaloma with diffuse pneumatosis involving the retroperitoneum, subcutaneous tissue, and mediastinum. An emergent exploratory laparotomy revealed perforation of the rectum below the peritoneal reflection into the retroperitoneum. An end-colostomy with Hartmann's operation was then performed intra-operatively. Despite operative treatment complicated by prolonged intubation, the patient succumbed to multiorgan failure and expired.

Severe constipation causing ischaemic stercoral perforation of sigmoid colon

“…Her Clozapine was suspended for several days due to her neutropenia. She was given G-CSF to improve her neutropenia to improve her chances of survival as it known that immunocompromised patients with sepsis have worse prognosis [ 9 ]. Fortunately, the patient recovered well post-operatively and was discharged to rehabilitation on day 10.…”