Stercoral Perforation of the Sigmoid Colon: Computed Tomography Findings

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

“…Pain may be diffuse or localized, and patients may be misdiagnosed with diverticulitis or appendicitis [8]. On physical examination, most patients have peritonitis, but rarely a palpable abdominal mass or fecaloma in the rectum [5,9]. In our patient, there was abdominal distention, tenderness on palpation in the lower quadrant and suprapubic region.…”

“…Plain x-ray study of the abdomen may demonstrate fecal loading, calcified fecaloma, or pneumo-mediastinum [5]. 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].…”

“…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.…”

Clinical Analysis of Stercoral Perforation without Mortality

“…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] .…”

“…Chronic constipation leads to fecal impaction in the colon, especially in the left colon, which can result in pressure erosion and ulcer [5,9,[13][14][15]. Constant pressure on the colonic wall causes rectal bleeding, anemia, and then localized ischemia and necrosis followed by perforation, known as stercoral perforation [5,8,9,[14][15][16].…”