Rare but relevant: a systematic review of stercoral perforation

Abstract

Background/Aims Knowledge of the aetiologies of large bowel perforation are fundamental to its management. Stercoral perforation is a rare cause associated with high mortality. Owing to the paucity of coverage of this condition in the literature, this review raises awareness of stercoral perforation among clinicians. Method A literature search of PubMed, Embase, MEDLINE, CINAHL, Ovid and Cochrane was performed. Key search terms included ‘stercoral, perforation’, ‘perforated’, ‘perforat*’ and ‘stercoral perforation’. Only literature published between December 2011 and July 2020 was included to avoid duplication. Results Twenty-nine papers were obtained giving an overall cohort of 58 patients. The median age was 58 years (range 2–83 years) and 72.4% (n=42) were female. Constipation was reported in 69% (n=40) and 20.7% (n=12) reported chronic opioid use. A computed tomography scan was performed in 94.8% (n=55) of cases and typically a Hartmann's procedure (n=40, 72.2%) was performed. The mortality rate was 17.2% (n=10). Conclusions The median age of patients with stercoral perforation has decreased from that found in previous studies and the mortality rate has improved. Chronic opioid users have also emerged as an important cohort. Early recognition, diligent decision making and focused perioperative care form the backbone of the definitive management of stercoral perforation.

Small Bowel Evisceration Through a Perforated Stercoral Ulcer

“…They are associated with stercoral colitis, lower gastrointestinal (GI) bleed, perforation, and peritonitis. 2 Perforated stercoral ulcers were reported to have a mortality between 30 and 60%, with recent literature reporting lower rates of mortality at 17%. 2 Clinical suspicion and imaging are essential for early diagnosis.…”

“…2 Perforated stercoral ulcers were reported to have a mortality between 30 and 60%, with recent literature reporting lower rates of mortality at 17%. 2 Clinical suspicion and imaging are essential for early diagnosis. Imaging depicts fecal impaction as well as signs of focal colonic inflammation such as thickening and fast stranding.…”

Management of Stercoral Colitis

“…2 It is associated with tricyclic antidepressants and long-term opiate use, with one-fifth of patients with stercoral perforation having opioid use disorder. 4 There is a high rate of concomitant comorbidities, such as diabetes mellitus, hypertension, malignancy, hypothyroidism, depression, dementia, and orthopedic injury or cerebrovascular accident, leaving patients bedridden. 5 Stercoral colitis rarely leads to perforation, with 0.7% of CT reports with fecal impaction or stercoral colitis having perforation.…”

Severe constipation causing ischaemic stercoral perforation of sigmoid colon

“…Stercoral perforation is a rare but life-threatening condition that is increasingly being recognised as a real entity associated with severe constipation. Systematic reviews thus far have identified approximately two hundred patients diagnosed with stercoral perforation, although it is likely that it has been significantly under-reported [ 1 , 2 ]. Although the mechanism is not fully understood, it is thought that impacted faecalomas may cause local pressure with subsequent ischaemia and necrosis of the colonic wall, leading to a stercoral ulcer or perforation [ 3 ].…”