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Tajmalzai A, Najah DM. Stercoral colitis due to massive fecal impaction: a case report and literature review. Radiol Case Rep 2021; 16:1946-1950. [PMID: 34149980 PMCID: PMC8193071 DOI: 10.1016/j.radcr.2021.04.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/04/2022] Open
Abstract
Stercoral colitis is a rare inflammatory condition involving the large bowel wall secondary to fecal impaction. Stercoral colitis has a clinical course ranging from non-complicated fecaloid impaction to colonic perforation. This case report aims to give a brief review of this condition and discuss its imaging findings. CASE PRESENTATION We herein report a case 74-year-old female who presented with abdominal pain, abdominal distension, and the absence of gas-feces discharge for a few days. The patient had a one-year history of chronic constipation and recent femoral neck fracture surgery. Physical examination shows abdominal distension with slight tenderness. Abdominal radiographs demonstrated bowel distention and fecal material in the colorectal regions. Computed tomography (CT) images demonstrated abundant fecal material with massive dilatation in the rectosigmoid colon, focal mural thickening, subtle pericolic fat stranding, and minimal free fluid in the abdominal and pelvic cavities. Based on these findings, the diagnosis of stercoral colitis was made. The patient was treated conservatively and eventually discharged with a good health condition. CONCLUSION Stercoral colitis seems to be more common in elderly patients with comorbid diseases. Chronic constipation causing fecal impaction is a major risk factor. CT scan is the most helpful imaging modality for the diagnosis of stercoral colitis. CT findings that should prompt the radiologist to consider this diagnosis include colonic dilatation containing impacted feces, mural thickening, and pericolic fat stranding. If the fecal impaction is not promptly relieved, life-threatening complications such as colonic perforation can occur.
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Affiliation(s)
- Abasin Tajmalzai
- Assistant Professor of Radiology, Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Din Mohammad Najah
- Associate Professor of Radiology, Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
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Gau CC, Lin LL, Wu CY, Huang JL. Stercoral Colitis in a Patient With Pediatric-Onset Systemic Lupus Erythematosus: Case Analysis and Review of the Literature. Front Pediatr 2021; 9:760517. [PMID: 34778151 PMCID: PMC8578821 DOI: 10.3389/fped.2021.760517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoantibody-related disease that affects multiple organs. Stercoral colitis (SC) is a rare type of inflammatory colitis with a high mortality rate. Here, we report the first case of pediatric-onset lupus in a case complicated by stercoral colitis. We also conducted a literature review of patients with SC under 30 years old to provide useful clues for rapid diagnosis at a young age. A 28-year-old female with a history of lupus and neuropsychiatric SLE was admitted with severe abdominal pain. She was found to have stercoral colitis during surgery. Two years later, the patient underwent Hartman's operation due to ischemia of the colon. In addition, 10 patients younger than 30 years old with a diagnosis of SC were analyzed based on clinical presentation, physical examination, laboratory exam, imaging and treatment. All cases had a favorable outcome without mortality. Stercoral colitis is a rare but lethal complication, emphasizing the importance of a multidisciplinary approach. Differential diagnosis should include stercoral colitis for patients with SLE developing unexplained sharp abdominal pain.
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Affiliation(s)
- Chun-Chun Gau
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Lun Lin
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Long Huang
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
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3
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Abstract
Enterolithiasis or formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis in the presence of the intestinal diverticula, surgical enteroanastomoses, blind pouches, afferent loops, incarcerated hernias, small intestinal tumors, intestinal kinking from intra-abdominal adhesions, and stenosing or stricturing Crohn’s disease and intestinal tuberculosis. Enterolithiasis is classified into primary and secondary types. Its prevalence ranges from 0.3% to 10% in selected populations. Proximal primary enteroliths are composed of choleic acid salts and distal enteroliths are calcified. Clinical presentation includes abdominal pains, distention, nausea, and vomiting of occasionally sudden but often fluctuating subacute nature which occurs as a result of the enterolith tumbling through the bowel lumen. Thorough history and physical exam coupled with radiologic imaging helps establish a diagnosis in a patient at risk. Complications include bowel obstruction, direct pressure injury to the intestinal mucosa, intestinal gangrene, intussusceptions, afferent loop syndrome, diverticulitis, iron deficiency anemia, gastrointestinal hemorrhage, and perforation. Mortality of primary enterolithiasis may reach 3% and secondary enterolithiasis 8%. Risk factors include poorly conditioned patients with significant obstruction and delay in diagnosis. Treatment relies on timely recognition of the disease and endoscopic or surgical intervention. With advents in new technology, improved outcome is expected for patients with enterolithiasis.
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Chakravartty S, Chang A, Nunoo-Mensah J. A systematic review of stercoral perforation. Colorectal Dis 2013; 15:930-5. [PMID: 23331762 DOI: 10.1111/codi.12123] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 10/19/2012] [Indexed: 12/29/2022]
Abstract
AIM Stercoral perforation is a rarely suspected life-threatening condition. Early diagnosis is difficult but essential. A comprehensive systematic review was performed to evaluate its presentation, diagnosis and treatment. METHOD A systematic review was carried out of Embase, MEDLINE, PubMed and Cochrane databases for all articles published between 1998 and 2011. Only studies describing stercoral perforation were included. RESULTS Twenty-four relevant articles were found including 137 patients (median age = 62 years) with stercoral perforation, of whom 81% had chronic constipation. Stercoral perforation was diagnosed by CT scan in 90% of 31 patients, with the commonest findings being a combination of faecal impaction (84%) and subphrenic (90%) or extraluminal air (61%). The commonest site of perforation was the sigmoid colon (50%) followed by the rectosigmoid junction (24%). The overall mortality was 34%. CONCLUSION Stercoral perforation should be suspected in elderly and chronically constipated patients with unexplained abdominal pain and investigated appropriately with a CT scan to allow timely and optimal treatment.
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Affiliation(s)
- S Chakravartty
- Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK.
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Kwag SJ, Choi SK, Park JH, Jung EJ, Jung CY, Jung SH, Ju YT. A stercoral perforation of the rectum. Ann Coloproctol 2013; 29:77-9. [PMID: 23700575 PMCID: PMC3659247 DOI: 10.3393/ac.2013.29.2.77] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 03/15/2013] [Indexed: 01/17/2023] Open
Abstract
A stercoral perforation of the rectum due to a fecaloma is a rare disease with a high mortality rate. Although multiple case reports of colonic perforations have been published, the data regarding rectal perforations are limited. This case report will highlight one such case of a stercoral rectal perforation that was successfully treated with a laparoscopic operation.
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Affiliation(s)
- Seung-Jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
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Hajdu Z, Romeo SJ, Fleming PA, Markwald RR, Visconti RP, Drake CJ. Recruitment of bone marrow-derived valve interstitial cells is a normal homeostatic process. J Mol Cell Cardiol 2011; 51:955-65. [PMID: 21871458 DOI: 10.1016/j.yjmcc.2011.08.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/12/2011] [Accepted: 08/09/2011] [Indexed: 01/09/2023]
Abstract
Advances in understanding of the maintenance of the cardiac valves during normal cardiac function and response to injury have led to several novel findings, including that there is contribution of extra-cardiac cells to the major cellular population of the valve: the valve interstitial cell (VIC). While suggested to occur in human heart studies, we have been able to experimentally demonstrate, using a mouse model, that cells of bone marrow hematopoietic stem cell origin engraft into the valves and synthesize collagen type I. Based on these initial findings, we sought to further characterize this cell population in terms of its similarity to VICs and begin to elucidate its contribution to valve homeostasis. To accomplish this, chimeric mice whose bone marrow was repopulated with enhanced green fluorescent protein (EGFP) expressing total nucleated bone marrow cells were used to establish a profile of EGFP(+) valve cells in terms of their expression of hematopoietic antigens, progenitor markers, fibroblast- and myofibroblast-related molecules, as well as their distribution within the valves. Using this profile, we show that normal (non-irradiated, non-transplanted) mice have BM-derived cell populations that exhibit identical morphology and phenotype to those observed in transplanted mice. Collectively, our findings establish that the engraftment of bone marrow-derived cells occurs as part of normal valve homeostasis. Further, our efforts demonstrate that the use of myeloablative irradiation, which is commonly employed in studies involving bone marrow transplantation, does not elicit changes in the bone marrow-derived VIC phenotype in recipient mice.
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Affiliation(s)
- Zoltan Hajdu
- Department of Regenerative Medicine and Cell Biology Medical University of South Carolina, Charleston, SC 29425, USA
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Kumar P, Pearce O, Higginson A. Imaging manifestations of faecal impaction and stercoral perforation. Clin Radiol 2011; 66:83-8. [PMID: 21147303 DOI: 10.1016/j.crad.2010.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 08/19/2010] [Indexed: 11/19/2022]
Abstract
Stercoral perforation can be defined as perforation of the bowel due to pressure necrosis from a faecal mass. It is an uncommon but life-threatening complication of unresolved faecal impaction. In this review, we highlight the important computed tomography (CT) findings of faecal impaction and stercoral perforation of the colon and subsequent therapeutic options in the adult population.
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Affiliation(s)
- P Kumar
- Radiology Department, Queen Alexandra Hospital, Cosham, Portsmouth, UK
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Nam JK, Kim BS, Kim KS, Moon DJ. Clinical Analysis of Stercoral Perforation of the Colon. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 55:46-51. [DOI: 10.4166/kjg.2010.55.1.46] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jung Kwang Nam
- Department of Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Byung Seok Kim
- Department of Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Kyung Soo Kim
- Department of Pathology, Kwangju Christian Hospital, Gwangju, Korea
| | - Duk Jin Moon
- Department of Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Giant faecaloma causing perforation of the rectum presented as a subcutaneous emphysema, pneumoperitoneum and pneumomediastinum: a case report. Eur J Emerg Med 2008; 14:351-3. [PMID: 17968202 DOI: 10.1097/mej.0b013e3282004952] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Constipation with faecal impaction is a common condition, which may lead to serious potential complications. Among such complications, stercoral perforation has been rarely reported in the literature. We report a single case of 75-year-old woman, with a massive faecal impaction, which resulted in a rectum perforation, presented as a pneumoperitoneum, pneumomediastinum and subcutaneous emphysema. We present this case to remind physicians that neglected accumulation of faecal matter in the rectum may lead to ischemia and perforation of the colon and rectum. This case illustrates that severe chronic constipation requires adequate management, including disimpaction and aggressive medical treatment. Appropriate operative treatment may be life-saving.
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Heffernan C, Pachter HL, Megibow AJ, Macari M. Stercoral colitis leading to fatal peritonitis: CT findings. AJR Am J Roentgenol 2005; 184:1189-93. [PMID: 15788592 DOI: 10.2214/ajr.184.4.01841189] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Stercoral colitis is an inflammatory process involving the colonic wall related to fecal impaction. Our purpose was to describe the imaging findings of stercoral colitis and ulceration and to emphasize the potential serious clinical implications of the condition. CONCLUSION Fecal impaction may lead to ischemic pressure necrosis and subsequent colonic perforation. In the appropriate clinical setting, the imaging findings that should prompt the radiologist to consider this diagnosis are the presence of fecal impaction, focal colonic wall thickening, and adjacent stranding of the fat. If the fecal impaction is not promptly relieved, the condition can lead to colonic perforation, peritonitis, and patient demise.
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Affiliation(s)
- Cathleen Heffernan
- Department of Radiology and Abdominal Imaging, NYU Medical Center, 560 First Ave., Ste. HW 207, New York, NY 10016, USA
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Maurer CA, Renzulli P, Mazzucchelli L, Egger B, Seiler CA, Büchler MW. Use of accurate diagnostic criteria may increase incidence of stercoral perforation of the colon. Dis Colon Rectum 2000; 43:991-8. [PMID: 10910249 DOI: 10.1007/bf02237366] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Stercoral perforation of the colon is reported to be a rare disease with poor prognosis. The aim of this study was to determine the frequency of stercoral perforation of the colon, to define diagnostic criteria for stercoral perforation of the colon, and to analyze the patient outcome in a university hospital gastrointestinal surgery unit. METHODS From November 1993 until November 1998 all surgically treated patients with a colorectal disease were prospectively recorded in a computerized database. Diagnosis of stercoral perforation of the colon was made if 1) the colonic perforation was round or ovoid, exceeded 1 cm in diameter, and lay antimesenteric; 2) fecalomas were present within the colon, protruding through the perforation site or lying within the abdominal cavity; and 3) pressure necrosis or ulcer and chronic inflammatory reaction around the perforation site were present microscopically. Any additional colon pathology led to exclusion from the diagnosis of stercoral perforation of the colon. Using the same criteria, 81 cases in the literature were found to qualify and were further analyzed. RESULTS In a five-year period 1,295 patients underwent colorectal interventions through laparotomy. A total of 566 (44 percent) cases were emergencies, 220 (17 percent) of these caused by colonic perforation. Seven patients had stercoral perforation of the colon. The incidence of stercoral perforation of the colon was 0.5 percent of all surgical colorectal procedures through laparotomy, 1.2 percent of all emergency colorectal procedures, and 3.2 percent of all colonic perforations. The mean age of the patients was 59 (median, 64; range, 22-85) years. All perforations were situated in the left hemicolon or upper rectum. The round or ovoid perforation had a mean diameter of 3.6 cm. Fecalomas were present in all patients and protruded from the perforation site or were found within the free abdominal cavity in three of them. Generalized stercoral peritonitis was a constant finding. Using a colonic resection without immediate restoration of continuity, an extensive intraoperative lavage, and antibiotics, there was no in-hospital mortality. Analysis of the reports in the literature revealed additionally that 28 percent of patients with stercoral perforation of the colon have multiple stercoral ulcers in the colon and that substantial mortality is encountered if only minor surgical procedures of treatment are used. CONCLUSIONS The incidence of stercoral perforation of the colon seemed to have been underestimated. The reason for this might be the lack of defined diagnostic criteria for this disease. Low mortality is obtained by early surgical eradication of the affected part of the colon, including all stercoral ulcers, and by aggressive therapy for peritonitis.
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Affiliation(s)
- C A Maurer
- Department of Visceral and Transplantation Surgery and Institute of Pathology, University of Berne, Switzerland
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Gomez HF, Brent JA, Munoz DC, Mimmack RF, Ritvo J, Phillips S, McKinney P. Charcoal stercolith with intestinal perforation in a patient treated for amitriptyline ingestion. J Emerg Med 1994; 12:57-60. [PMID: 8163807 DOI: 10.1016/0736-4679(94)90013-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of a patient who developed an intestinal perforation secondary to a charcoal stercolith is reviewed. The case involves a young female on methadone maintenance who received multiple-dose charcoal therapy for an amitriptyline ingestion. Peritoneal signs developed several days after admission, and an exploratory laparotomy was done. A perforation measuring 4 cm in diameter was found in the posterior wall of the sigmoid colon. A 120-gm obstructing charcoal mass was found at the site of the perforation. Previous reports of intestinal obstruction secondary to charcoal inspissation are noted, and case similarities are discussed. All reported cases of charcoal obstruction involve the administration of multiple-dose-activated charcoal in the treatment of ingestions of medications known to have antiperistaltic activity. With a rare potential of mechanical obstruction, the decision to use repetitive-dose charcoal therapy should be made judiciously when the ingested toxin or coincident therapeutic medications have antiperistaltic activity.
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Affiliation(s)
- H F Gomez
- Rock Mountain Poison and Drug Center, Denver, Colorado
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Mezwa DG, Feczko PJ, Bosanko C. RADIOLOGIC EVALUATION OF CONSTIPATION AND ANORECTAL DISORDERS. Radiol Clin North Am 1993. [DOI: 10.1016/s0033-8389(22)00326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Abstract
Stercoral perforation of the colon is rare. The 64 reported cases are reviewed to define the syndrome of stercoral perforation, and to facilitate accurate diagnosis and treatment. Features of localized or generalized peritonitis were universal; however, only 11 per cent were correctly diagnosed before operation. Recognition that the disease involves a segment of colon rather than only the focal point of perforation is essential to adequate surgical treatment. It is postulated that this is the reason for the higher postoperative mortality following closure of the perforation and proximal colostomy (57 per cent) or exteriorization alone (43 per cent), compared with resection of the diseased segment and exteriorization (32 per cent). Resection and exteriorization is therefore the treatment of choice is most situations.
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Affiliation(s)
- J W Serpell
- Department of Surgery, St. Thomas' Hospital, London, UK
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Abstract
Fecal impaction is a common disorder with variable presentation and many potential complications. Its pathophysiology is complex, and the treatment is often difficult and frustrating. Preventive measures are likely to be cost effective in populations at high risk, such as institutionalized or debilitated elderly people, mentally ill patients, those with chronic renal failure or cancer, and those who are neurologically impaired.
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Affiliation(s)
- K Wrenn
- Department of Medicine, University of Rochester, NY
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Abstract
The case of a patient with colonic obstruction secondary to impaction of a large calcified fecolith is presented. Clinical features, radiographic findings and treatment are described and the literature is reviewed.
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Abstract
Stercoraceous perforation of the colon is seen infrequently clinically, but the mortality of this entity remains high. Early diagnosis and treatment are essential if mortality is to be reduced. Emphasis is placed on the potential prevention of this entity. The case presented involves four confined stercoraceous perforations of the colon which were treated by resection and colostomy and from which the patient made a complete recovery.
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Leyland MJ, Brown PJ. Serum-ferritin in haemochromatosis. Lancet 1978; 1:874-5. [PMID: 76817 DOI: 10.1016/s0140-6736(78)90215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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