Value of CT in the Discrimination of Fatal from Non-Fatal Stercoral Colitis

Abstract

ObjectiveClinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC.Materials and MethodsTen patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports.ResultsSC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p = 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC.ConclusionCT appears to be valuable in discriminating fatal from non-fatal SC.

Stercoral colitis: diagnostic value of CT findings

“…In a recently published article, Wu et al (3) reported that dense mucosa sign had a significant correlation with fatal SC. They evaluated dense mucosa sign in unenhanced CT images and concluded that mucosal sloughing sign and pericolonic abscess have high specificity (100% and 93%, respectively) for the diagnosis of fatal SC.…”

“…On the other hand, presence of free fluid or abscess indicates a more complicated incident, since presence of fluid may suggest associated infection with or without accompanying leakage from the colon. Wu et al (3) reported that the incidence of CT signs of dense mucosa, perfusion defect, free fluid, and abnormal gas was statistically different between fatal and nonfatal SC. In addition to these CT features, we found affected colon segment length >40 cm to be associated with increased mortality in SC.…”

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

“…CT of the abdomen expedites diagnosis and treatment of stercoral colitis. CT findings of stercoral colitis include fecal impaction, pericolonic fat stranding, colon wall thickening > 3 mm, and proximal colonic dilatation [4,13]. In our patient's tomography, wall thickness was over 3 mm in the rectosigmoid region.…”

“…In stercoral colitis without perforation, 52% of patients can be treated non-operatively with a bowel regimen. The remainder deteriorates clinically and ultimately require surgery [13]. Methods to extract feces from the rectum, including digital disimpaction and enemas, do not improve abdominal discomfort [4].…”

Evaluating the Patient with Left Lower Quadrant Abdominal Pain

“…Multiple objective scales have been studied to quantify fecal loading on abdominal radiographs, mostly in pediatrics, and none are reliable. [73][74][75][76][77][78][79] Stercoral colitis is often not suspected before imaging and first suggested on CT. 80 There is no publication describing the MR imaging or ultrasound appearance of stercoral colitis.…”