Spontaneous perforation of the rectum with possible stercoral etiology: Report of a case and review of the literature

Abstract

Stercoral perforation of the colon or rectum is a rare cause of acute abdomen, with fewer than 70 cases documented in the literature. We report herein the case of a 60-year-old man who presented with anuria and epigastric pain with physical signs of peritonitis. An abdominal X-ray showed bilateral subphrenic free air accumulation, and an emergency laparotomy subsequently revealed perforation of the rectum, suggestive of a stercoral cause, which was treated by simple closure after debridement. Following an uneventful postoperative course, he was discharged from the hospital 3 weeks after his operation and is now doing well without having suffered any further gastrointestinal problems. The clinical features, diagnosis, and treatment of the disease are reviewed following the presentation of this case. Surgeons should be aware of the possibility of this fatal disease, despite its rare incidence. Furthermore, it is important to recognize the condition at an early stage because it has a significantly high mortality if not treated early. Conversely, the surgical outcome is satisfactory provided surgery is performed in due time.

Clinical Analysis of Stercoral Perforation without Mortality

“…Stercoral perforation is commonly found in the rectum or sigmoid colon [4,9]. The reasons why the left colon is the most common perforation site include its physiological characteristics such as declining water content of the stool, relatively poor blood supply, narrow diameter, and high intraluminal pressure [5,10]. Our results show a similar tendency, but trans- Colon perforation is associated with high mortality because of sepsis or septic shock [3][4][5]13].…”

“…The mortality rate of patients with stercoral perforation is considerably higher than that of patients with colon perforation by other causes because of a larger size of colon perforation, more extensive contamination of abdominal cavity with feces, and older patients with medical diseases and poor general performance status [15]. In the previous reports, postoperative mortality of patients with stercoral perforation was very high, 35-57% [5,9,10]. One paper reported that a 2-day delay in operation resulted in surgical mortality on the 7th postoperative day [9].…”

“…One paper reported that a 2-day delay in operation resulted in surgical mortality on the 7th postoperative day [9]. Therefore, early diagnosis and urgent surgical treatment of patients with stercoral perforation could improve survival [9,10,12] .…”

“…The risk factors for constipation could also be the risk factors for stercoral ulcer or perforation [9]. These risk factors include medications (narcotics, codeine, non-steroidal anti-inflammatory agents, tricyclic anti-depressants, and tranquilizers), intestinal motility disorders, underlying medical diseases (such as diabetes mellitus, hypothyroidism, Parkinson's disease, or stroke), or patients' condition (old age, bed-ridden status) [3,4,[9][10][11][12] .…”

An Unusual Perforation of the Colon: Report of Two Cases

“…3,[5][6][7][8] However, only 60% of the patients reported a history of chronic constipation. 9 In case 1, moreover, the retention of barium after an upper GI series performed 9 months previous to admission resulted in fecaloma and finally stercoral perforation. Only one case has been reported in which masses of inspissated barium caused a perforation of the rectum with an interval of 2 days after a barium meal study.…”