0418 Stercoral Colitis

Case presentation

2008-04-18R1 이진영

Case

이 @ 윤 66/M

Present illness

Chronic constipation hx.

최근 1 주일간 defecation 하지 못함 .

내원 3 일 전부터 epigastric discomfort.

내원 전일 abrupt periumbilical sever pain. Plain abdomen x-ray 상 free air 소견보여 transfer.

4cm perforation at cecum, antemesenteric side No intraluminal lesion No tumorous lesion Cecum and ascending

colon adhesion with inflammatory appearance with dirty material.

Mucosa unremarkable

Pathology

Microscopic

Stercoral colitis

Definition Inflammatory process of colonic wall

related to fecal impaction

Main causative factor : Severe chronic constipationelderly : often live in nursing homes

young patients : neurologically impaired

slow transit time : opiates, tricyclic antidepressants, tranquilizers

Stercoral colitisMechanism

Conglomeration of dehydrated fecal material

→ Increased intraluminal pressure

→ Decreases blood supply

→ Ischemia → ulceration and perforation

NeverthelessStercoral ulceration does not always occur among constipation cases

Not every stercoral ulceration results in colon perforation.

Stercoral colitis

Stercoral ulceration:

M/C in antimesenteric aspect of sigmoid colon hypoperfusive status

decreasing water content in the stool

narrow diameter

high intraluminal pressures

CT FindingUncomplicated

fecal impaction

Stranding of pericolonic fat

Presence of -extraluminal bubbles of gas -abscess

DiagnosisHystory of chronic constipation or fecal impaction Intraoperative findings

generalized peritonitis, colonic dilatationcolonic perforation size 1 cm or moreulcerations on the antimesenteric border If frank perforation occurs

-> fecal material within the peritoneal cavity in close proximity to the perforation site

Histologytransmural necrosisulcer margins sharply demarcated nonspecific inflammatory changes no additional colonic pathology is found

TreatmentMost cases of uncomplicated stercoral colitis

successfully treated with disimpaction

Stercoral perforation broad spectrum antibiotics : initiated in all the patient

resection of the colon segment with an end colostomy

primary repair

Underlying disease Tx

Mortality related to stercoral perforation

: 30% to 55% , prompt exploration may decrease that rate

Reference

Stercoral Colitis Leading to Fatal Peritonitis: CT Findings Cathleen et al.

AJR 2005; 184:1189-1193

Management of patients with stercoral perforation of the sigmoid colon: Report of five cases Wen-Shih Huang et al.

World J Gastroenterol  2006 January 21;12(3):500-503

Image of the Month—Perforated Stercoral Ulcer Arch Surg. 2007;142(1):98