Stercoral colitis complicated with ischemic colitis: a double-edge sword

Abstract

BackgroundStercoral colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with ischemic colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on abdominal perforation resulting from stercoral colitis. However, stercoral colitis complicated by ischemic colitis is rare. The purpose of this case report is to describe the potential challenges in the diagnosis and management of stercoral colitis with ischemic colitis.Case presentationAn 87 years old male with history of chronic constipation presents with severe abdominal pain to the emergency department. The patient was hemodynamically stable. On physical examination, the abdomen was mildly distended with moderate tenderness. Lab work was significant for leukocytosis and lactic acidosis. Abdominal CT scan revealed large amount of retained stool in the colon, bowel wall thickening and infiltration of peri-colonic fat, which were suggestive for stercoral colitis. Patient was started on IV fluids and antibiotics. He was given an enema, followed by laxative and manual disimpaction of stool. Colonoscopy was performed and biopsies were obtained. Tissue biopsy was significant for focal active colitis with regenerative glandular changes and neural hyperplasia.ConclusionElevated lactic acid level secondary to ischemia of the bowel wall with CT scan findings aid in establishing the diagnosis of stercoral colitis complicated with ischemic colitis. Urgent treatment with laxatives and fecal disimpaction is indicated to prevent perforation and peritonitis.

A case of stercoral colitis with marked elevation of serum carcinoembryonic antigen

“…It is related to patients being bedridden or having neuropsychiatric disorders, with a poor performance status and a history of chronic constipation along with other comorbidities . Patients with stercoral colitis usually present with abdominal pain and sometimes with distention, nausea, vomiting, melena, or diarrhea . Most patients have elevated white blood cell counts with a shift to the left.…”

“…[7][8][9] Patients with stercoral colitis usually present with abdominal pain and sometimes with distention, nausea, vomiting, melena, or diarrhea. 2,8,9 Most patients have elevated white blood cell counts with a shift to the left. Moreover, there may be signs of peritoneal irritation or septic state; however, physical examination or laboratory tests are not always reliable for diagnosing stercoral colitis.…”

“…Stercoral colitis is an inflammatory condition of the colon caused by fecal impaction. The impacted feces increase intraluminal pressure, leading to ischemia of the bowel that can result in ulceration and subsequent intestinal perforation or ischemic colitis . A history of chronic constipation is a known risk factor for stercoral colitis, and the mortality rate in perforated cases is reported to be 32%‐57% .…”

“…The impacted feces increase intraluminal pressure, leading to ischemia of the bowel that can result in ulceration and subsequent intestinal perforation or ischemic colitis. [1][2][3] A history of chronic constipation is a known risk factor for stercoral colitis, and the mortality rate in perforated cases is reported to be 32%-57%. 1 Immediate surgery should be considered in perforated cases and sometimes in nonperforated cases because they can be complicated by ischemic colitis, which can lead to perforation, peritonitis, septic shock, and eventual death if not treated promptly.…”

“…1 Immediate surgery should be considered in perforated cases and sometimes in nonperforated cases because they can be complicated by ischemic colitis, which can lead to perforation, peritonitis, septic shock, and eventual death if not treated promptly. 2 Carcinoembryonic antigen (CEA) is a widely used tumor marker for colorectal cancer and various other types of cancer. Serum CEA levels can also be increased in various nonmalignant conditions, including gastrointestinal disorders such as inflammatory bowel disease, [3][4][5][6] and it is reported that ulcerative colitis activity is correlated with serum CEA levels.…”