Stercoral perforation of the rectum with faecal peritonitis and pneumatosis coli: A case Report

Abstract

Colonic perforation due to impacted faeces or faecaloma is a relatively uncommon presentation with grave prognosis. If left untreated, it can be life threatening due to complications like faecal peritonitis. Till date, fewer than 150 cases have been reported mostly in the English surgical literature describing constipation as the most common underlying etiology. Involvement of rectum is rare with very limited data published in this context. We present a case of stercoral perforation involving the rectum with associated faecal peritonitis and pneumatosis coli.

Pneumatosis Intestinalis and Portal Venous Gas: An Unusual Complication of Fecal Impaction

“…Of those etiologies, stercoral perforation is the most life-threatening, and represents 3.2% of all colonic perforations [2]. This is an unusual cause of PI and/or PVG as the mechanism is due to a formation of a fecaloma large enough to cause distension of the bowel with a significant increase in pressure causing a perforation [2,3]. Our 48-year-old male in this study presented without a fever, one episode of emesis and abdominal distension.…”

“…Three general clinical etiologies have been postulated to cause PI with or without PVG: 1) Mechanical disease; 2) Mesenteric ischemia; and 3) Benign idiopathic [1]. Of those etiologies, stercoral perforation is the most life-threatening, and represents 3.2% of all colonic perforations [2]. This is an unusual cause of PI and/or PVG as the mechanism is due to a formation of a fecaloma large enough to cause distension of the bowel with a significant increase in pressure causing a perforation [2,3].…”

Pelvic Rectal Stercoral Perforation Resulting in Diffuse Pneumatosis

“…Stercoral perforation of the colon is a rare, life-threatening entity, first reported by Berry in 1894, which represents 3.2% of all colonic perforations [1,8,9]. There is an equal incidence among males and females, and the mean age of presentation is 59 years, with an age range of 22-85 years [10].…”

“…Stercoral perforation due to a fecaloma is an unusual cause of perforation usually seen in elderly, debilitated, and chronically constipated patients [4]. Chronic constipation and hypomobility caused by medical conditions (hypothyroidism, cognitive impairment, diabetes, scleroderma) or medications (use of opioids, anticholinergics, antacids, and tricyclic antidepressants) may also lead to perforation [1,5]. In one study, nearly one in two patients (47%) with stercoral perforation expired from complications [6].…”

Management of sigmoid perforation from chronic constipation and manual disimpaction

“…Factors that predispose patients to constipation include lifestyle (dehydration, immobility and low fibre), anatomic (stricture, anal fissure and extrinsic mass), neurological (spinal cord injury, Parkinson’s disease, dementia and Hirschsprung’s disease), metabolic (hypothyroidism, hypocalcaemia and hypokalaemia) or medication induced (opioids and antipsychotics). Chronic constipation can lead to faecal impaction, stercoral ulcer formation and perforation, which can be life threatening with an associated mortality rate of 47% 3. Faecal impaction can be defined as symptoms of constipation in the presence of an obstructing faecal mass diagnosed on imaging or digital rectal exam.…”