Stercoral perforation requiring a total colectomy: a challenging and extreme case

Abstract

however, in this setting, the decision to reconstruct in this manner is determined and performed in one stage rather than requiring a subsequent surgery and intra-flap pedicle dissection as we report. Haddock et al. describe a single-stage double-free flow-through reconstruction for a complex scalp defect, utilizing an ALT flap with the lateral circumflex femoral artery as a large calibre flowthrough vessel to allow for end-to-end anastomosis with the thoracodorsal artery supplying a large LD flap. 1 The LD flap is commonly used as a flow-through flap in extremity reconstruction, and has also been used effectively in scalp reconstruction in a series of seven single-stage cases. 6 While these utilize the principles of flow through, they differ from our case as delicate dissection of the RFFF pedicle that had been previously used to reconstruct the scalp was not required.This case highlights the importance of considering a flowthrough flap reconstruction in a scalp defect with limited recipient vessel options. This technique should be considered as part of the reconstructive armamentarium for those managing complex serially reconstructed tissue defects.

Severe constipation causing ischaemic stercoral perforation of sigmoid colon

“…Histopathology confirmed the presence of a full thickness perforation approximately 50 mm in length, with surrounding ischaemic necrosis of the mucosa and a massive faecaloma, confirming the diagnosis of stercoral perforation associated with ischaemia. Although there have been limited case reports of stercoral perforation described in schizophrenic patients requiring Clozapine and other antipsychotics that have a constipating effect [ 6 , 10 ], Ms IW had been on long-term Clozapine and her stercoral perforation was believed to be associated with her comorbidities and adjuvant chemotherapy, not just associated with Clozapine.…”

“…The distal colon is most commonly affected due to inspissated faecalomas [ 5 ]. Risk factors associated with stercoral perforation include chronic constipation, increasing age, smoking, chronic opioid use/medications associated with constipation such as anti-psychotic drugs including clozapine [ 6 , 7 ]. Diagnosis is confirmed by CT imaging of the abdomen and pelvis usually necessitating a laparotomy.…”