A case of colonic obstruction combined with ischemic colitis

Abstract

CT scan of the abdomen showing a large amount of feces in the anterior descending recto‐sigmoid colon with wall thickening (red arrow) and surrounding fat stranding (yellow arrow) suggestive of stercoral colitis.

Non-perforated Stercoral Colitis patients with septic shock have a higher mortality than their perforated counterparts. A case report and review of literature

“…Within the individual case reports were 13 cases of PSC with 3 fatalities [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] . There were 9 cases total of NPSC with 4 fatalities [4] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] . When the NPSC cases were stratified for sepsis, a total of 4 cases with 2 fatalities was yielded [24] , [25] , [26] , [27] .…”

A Case of Stercoral Colitis Complicated by Ischemic Colitis in a Young Patient

“…The pathogenesis of stercoral colitis results from stagnant hard fecal material resulting in decreased blood flow due to compression of the walls of the colon. This can further lead to ulceration, pressure necrosis, and eventually bowel perforation if the fecal impaction is not promptly diagnosed and treated [ 6 ]. Ischemic pressure necrosis occurs when colonic distention increases pressure above the bowel wall capillary perfusion pressure.…”

Altered Mental Status as the Primary Presentation of Stercoral Colitis

“…Bowel regimen typically includes a combination of oral agents such as senna, docusate, MiraLAX, Dulcolax as well as rectal enemas. Manual disimpaction is extremely effective at decreasing intraluminal pressure within the colon and reducing the risk of ulceration secondary to high pressure placed on colonic walls by a fecaloma mass [5]. More than 50% of stercoral colitis patients can be managed with disimpaction and bowel regimen, whereas those with severe complications and concern for bowel perforation, and peritonitis may require prompt surgical treatment such as colectomy, hemicolectomy, or sigmoidectomy [5,8].…”

“…Manual disimpaction is extremely effective at decreasing intraluminal pressure within the colon and reducing the risk of ulceration secondary to high pressure placed on colonic walls by a fecaloma mass [5]. More than 50% of stercoral colitis patients can be managed with disimpaction and bowel regimen, whereas those with severe complications and concern for bowel perforation, and peritonitis may require prompt surgical treatment such as colectomy, hemicolectomy, or sigmoidectomy [5,8]. Prompt intervention is important to prevent perforation and further complications such as septic shock and multiorgan failure [2].…”

“…Less than 200 cases of this condition have been documented since the first known case in 1894. Given our aging population, the incidence of stercoral colitis is likely to increase [1] therefore, early diagnosis and treatment is crucial to decrease overall morbidity and mortality [5]. Here, we present two cases of stercoral colitis in elderly with altered mental status successfully treated with fecal disimpaction and bowel regimen, thereby avoiding late-stage complications of the disease process.…”