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

Abstract

Stercoral colitis with perforation of the colon is an uncommon, yet life-threatening cause of the acute abdomen. No one defining symptom exists for stercoral colitis; it may present asymptomatically or with vague symptoms. Diagnostic delay may result in perforation of the colon resulting in complications, even death. Moreover, stercoral perforation of the colon can also present with localized left lower quadrant abdominal pain masquerading as diverticulitis. Diverticular diseases and stercoral colitis share similar pathophysiology; furthermore, they may coexist, further complicating the diagnostic dilemma. The ability to decide the cause of perforation in a patient with both stercoral colitis and diverticulosis has not been discussed. We, therefore, report this case of stercoral perforation in a patient with diverticulosis and include a discussion of the epidemiology, clinical presentation, and a review of helpful diagnostic clues for a rapid differentiation to allow for accurate diagnosis and treatment.

Pelvic Rectal Stercoral Perforation Resulting in Diffuse Pneumatosis

“…CT also has a reported accuracy ranging from 82% to 90% [15]. Histopathology findings are usually significant for ischemic necrosis and nonspecific inflammatory changes [16].…”

A rare cause in the differential diagnosis of abdominal pain: stercoral colitis

“…Free air on plain x-ray study is seen in only 70% of patients with perforated stercoral colitis [4][5]9]. Diagnosis of stercoral colitis is made in only 10% of patients before surgery, and many patients develop colonic perforation, peritonitis, septic shock, and death [10][11][12]. CT of the abdomen expedites diagnosis and treatment of stercoral colitis.…”

“…Methods to extract feces from the rectum, including digital disimpaction and enemas, do not improve abdominal discomfort [4]. In stercoral colitis with perforation, mortality is nearly 100% in patients treated nonoperatively, compared to 35-40% in patients treated operatively [9,11]. Stercoral colitis should be managed timely and adequately to avoid potentially life-threatening complications.…”

A Clinical Case Study and Review of the Literature on Stercoral Ulcer Perforation: An Uncommon but Deadly Culprit

“…It is considered the standard of care. SUP is associated with nearly 100% mortality when nonoperative treatment is sought, compared to 35% to 40% with surgery [12,20,21]. Surgical intervention with Hartmann's closure is associated with a mortality rate of 32%, while colostomy only, and proximal colostomy have mortality rates of 43%, and 57% respectively [22].…”