Differentiation between stercoral perforation and colorectal cancer perforation

Abstract

SUMMARY OBJECTIVE: To determine the computed tomography (CT) signs associated with stercoral perforation and colorectal cancer perforation. MATERIALS AND METHODS: From May 2003 to Feb. 2015, all surgically and pathologically confirmed patients with stercoral perforation (n=8, mean age 68.3 years) or colon cancer perforation (n=11, mean age 66.3 years) were retrospectively reviewed by two board-certified radiologists blinded to the proven diagnosis. The following CT findings were evaluated and recorded for each patient: wall thickness of the distal colon adjacent to perforation site, pattern of the colon wall thickening and enhancement, length of the thickened bowel wall, presence of fecaloma, degree of proximal colon dilatation, and pericolonic inflammation or presence of pericolonic abscess, and number of enlarged pericolonic lymph nodes. These findings were correlated with the pathologic diagnosis. RESULTS: The mean thickness of the distal colonic wall adjacent to the perforation site was 13.6 mm in patients with colorectal cancer perforation and 5.1 mm with stercoral perforation, which was statistically different. There was a significant correlation between colorectal cancer perforation and eccentric wall thickening (p<0.01). CT findings of layered enhancing wall thickening (p<0.01) and the presence of fecaloma in the proximal colon (p<0.01) were significant findings for stercoral perforation. Patients with colorectal cancer displayed more pericolonic lymph nodes (mean 2.27, p<0.05). CONCLUSION: Fecaloma in the proximal colon and layered enhancing wall thickening adjacent to perforation site are likely due to stercoral perforation. Eccentric bowel wall thickening at the distal portion of the perforation site with many enlarged pericolonic lymph nodes is most likely due to colorectal cancer perforation.

Spontaneous Perforation of the Colon - A possible Third Classification

“…Dear Editor, The article by Moon et al 1 brings a very important differential diagnosis of spontaneous perforation of the colon (SPC), pathology seldom recognized by surgeons. The frequency of this emergency condition may be underestimated and consequently rare reported.…”

“…He had a history of arterial hypertension (treated with captopril and hydrochlorothiazide), alcohol and tobacco consumption, and chronic constipation. Stercoral perforation usually occurs in patients with chronic constipation 1,5 . The patient reported constipation in the last 30 years, worsening in the last 9 years.…”

“…Stercoral perforation occurs more frequently on the antimesenteric border of the rectosigmoid, an area more prone to ischemia because of anatomical vascularization 2 . The SPC has been classified as stercoral and idiopathic 1,2 . Stercoral perforations are those with rounded shape perforation with more than 1 cm in diameter; the colon should be full of stool, which diffuses to the abdominal cavity through the perforation; microscopical examination should evidence ischemia and necrosis of colonic mucosa leading to feculent ulcer and acute inflammatory reaction surrounding the perforation site; and external injury or other diseases such as obstruction, tumors, and diverticulosis must be excluded.…”

Stercoral perforation: A rare case and review

“…Most of study in literature report antimesenteric border as the site of perforation and this could be due to the blood supply being farthest from the mesentery. Moon, et al [6], study reported that, Faecaloma in the proximal colon with wall thickening next to perforated site are most likely due to Stercoral perforation. Whereas, Eccentric bowel wall thickening distal to the perforated site with enlarged pericolonic lymph nodes is most likely due to colorectal cancer perforation [6].…”

Stercoral re-perforation after colostomy takedown: a case report

“…Accurate diagnosis can be difficult when free air is observed in the intraperitoneal space without a definite perforation site, although imaging studies have improved over the last decade [ 2 ]. Moreover, SP is not well-differentiated from other causes of perforation such as diverticulitis or malignancy [ 4 ].…”