Stercoral perforation of the colon: a mortal consequence of chronic constipation in the elderly: a case report

Abstract

The stercoral perforation is a mortal condition. It affects elderly patients who have a long history of chronic and severe constipation as well as constitutes a surgical emergency whose prognosis, often grim, depends on the early diagnosis and treatment. We report the case of a stercoral colon perforation which occurred in an 89-year-old patient. The clinical symptomatology was that of an acute peritonitis evolving for four days. The diagnosis was only made intraoperatively and the surgical gesture was a resection of the involved left colon segment and Bouilly Volkmann colostomy. The consequences were unfortunately marked by a resistant septic shock resulting in the death of the patient on the 1 st postoperative day. The diagnosis of stercoral colon perforation, which is often difficult and delayed, must be known by all physicians who manage an increasingly older patient population.

Stercoral colitis in the emergency department: a review of the literature

“…The three most common anatomic locations affected by SC are the apex of the sigmoid colon, the antimesenteric border of the rectosigmoid junction, and the anterior rectum [ 1 , 7 , 12 , 14 , 15 ]. These regions are thought to be more susceptible due to several factors that contribute to significantly increased intraluminal pressure: (1) decreasing water content of the stool as water gets absorbed along the colon, (2) relatively narrow luminal diameter, particularly at the rectosigmoid junction, makes it hard for stool to pass through, and (3) poor perfusion to these regions, especially over the antimesenteric aspect of the bowel, because blood enters from the mesenteric side [ 1 , 12 , 16 ].…”

“…CT of the abdomen and pelvis with contrast is the gold standard for diagnosing SC and stercoral perforation [ 5 , 36 , 38 ]. CT accuracy for diagnosing stercoral perforation has been estimated at 82–90% [ 14 , 15 ]. Plain radiographs may suggest the diagnosis, but they are relatively nonspecific and unreliable.…”

Non-perforated Stercoral Colitis patients with septic shock have a higher mortality than their perforated counterparts. A case report and review of literature

“…Within the individual case reports were 13 cases of PSC with 3 fatalities [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] . There were 9 cases total of NPSC with 4 fatalities [4] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] .…”

“…Combining the cases of PSC from the individual case reports [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , with the cases of PSC from the case series [5] , [28] , [29] , there was a total of 23 cases. Table 2-1 illustrates the comparison in data obtained between PSC and NPSC with sepsis.…”

Acute Constipation and A Stercoral Perforation: A Case Report

“… 2 In the wrong patient, this can ultimately lead to their demise with reported cases of mortalities following late diagnosis of stercoral perforation. 5 …”