A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent Patient

Abstract

Stercoral perforation of the colon is rare but carries with it significant morbidity and mortality. Stercoral perforation usually occurs in elderly, immobile patients with chronic constipation. In this manuscript, we report the case of stercoral perforation in a patient due to chronic heroin dependence. We report the case of a 56-year-old male patient with stercoral perforation, diagnosed by computed tomography, secondary to heroin dependence, requiring proctocolectomy and an end ileostomy. There are very few reports in the literature describing cases of stercoral perforation and questions have been asked about the importance of preoperative cross-sectional imaging. In our case, the diagnosis of stercoral perforation was made only on CT. Although this is not the first such case to be reported, it is significant as preoperative CT imaging was influential not only in determining the aetiology of the abdominal distension seen on the plain film, but also in detecting the pneumoperitoneum which was not evident clinically or on plain radiographs.

Spontaneous colonic perforation in adults: Evaluation of a pooled case series

“…A literature search was conducted on the research database (MEDLINE) for all articles published in English from 1998 to 2017. MEDLINE retrieved 39 case reports, 7 , 10 – 47 including 46 patients, and four case series including 175 patients. 1 , 2 , 5 , 48 To this end, a total of 228 patients with SCPA were identified ( Figure 1 ).…”

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] .…”

“…Combining the cases of PSC from the individual case reports [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , with the cases of PSC from the case series [5] , [28] , [29] , there was a total of 23 cases. Table 2-1 illustrates the comparison in data obtained between PSC and NPSC with sepsis.…”

Prognostic Factors of Patients with Stercoral Perforation of the Colon

“…1 SPC is observed most com-monly in elderly patients in immobile and moribund states with chronic constipation. 2,3 The incidence of SPC is expected to rise because of the increased life expectancy and the aging population.…”