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 impactionMain 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 casesNot every
stercoral ulceration results in colon perforation.
Stercoral colitisStercoral 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 findingsgeneralized 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 siteHistologytransmural necrosisulcer margins sharply
demarcated nonspecific inflammatory changes no additional colonic
pathology is found
TreatmentMost cases of uncomplicated stercoral colitis
successfully treated with disimpactionStercoral perforation broad
spectrum antibiotics : initiated in all the patient resection of
the colon segment with an end colostomy primary repair Underlying
disease TxMortality related to stercoral perforation : 30% to 55% ,
prompt exploration may decrease that rate
ReferenceStercoral Colitis Leading to Fatal Peritonitis: CT
Findings Cathleen et al. AJR 2005; 184:1189-1193Management 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):500-503Image of the MonthPerforated Stercoral Ulcer Arch
Surg.2007;142(1):98
