Constipation-Associated Stercoral Colitis

Abstract

A 9-year-old white girl with a history of constipation presented to the emergency department with a few weeks of intermittent stool incontinence without any reported changes in diet or difficulty tolerating food or fluids by mouth. On the day of presentation, she developed nausea and nonbloody, nonbilious emesis, as well as multiple, loose, nonbloody stools, after becoming acutely ill during lunch at school. There was no reported fever or suspicious food intake. On examination, she was noted to be afebrile, hypotensive, and tachycardic with abdominal tenderness. Her blood work was notable for a marked leukocytosis of 66,000 and a subsequent computed tomography scan of her abdomen was performed. The imaging test identified a large fecaloma with surrounding colonic inflammation concerning for stercoral colitis. The child underwent urgent manual disimpaction and was hospitalized for supportive care with subsequent recovery and return to her normal state of health. Follow-up testing during her hospital stay did not reveal any other infectious or physiologic cause for her constipation and colitis.

Mission Disimpaction: Endoscopic Management of Stercoral Colitis in an Adolescent

“…Typical demographic reports of stercoral colitis reference the elderly, associated with numerous comorbidities contributing to a state of chronic constipation. Reports of pediatric cases of stercoral colitis are limited in this already uncommon entity, with total cases in the single digits ( 1 ). Risk for chronic constipation is well cited during select pediatric developmental milestones, in addition to pediatric subgroups involving congenital anorectal malformations, autism spectrum disorder, and mental health disorder ( 4 ).…”

“…Stercoral colitis is an uncommon form of inflammatory colitis resulting from focal compression of colonic mucosal wall and vasculature by large hardened fecal material, termed fecaloma, or synonymous to a large fecalith. Colonic injury from fecaloma impaction involves mechanisms relating to pressure necrosis and increase of intraluminal pressure, potentiating risk of ischemia with progression to ulceration and perforation ( 1 ). Associated high morbidity and mortality in stercoral colitis are likely attributable to delay in recognition of diagnosis and thus management to avoid complications of ischemic colitis, sepsis, and eventual perforation.…”

Spontaneous Recurrent Pneumoperitoneum due to Opioid-Induced Constipation: A Case Report

“…We postulate that stercoral colitis may result in micro-perforation and accumulation of gas and hence manifests as pneumoperitoneum. It is crucial to diagnose and address stercoral colitis and prevent bowel perforation [13][14][15][16].…”

Stercoral Colitis in a Patient With Pediatric-Onset Systemic Lupus Erythematosus: Case Analysis and Review of the Literature

“…To date, fewer than 200 cases of stercoral colitis or stercoral perforation have been reported, and only 10 patients [3 males (9-11) and 7 females (12)(13)(14)(15)(16)(17)] younger than 30 years old are reported in PubMed. The analysis of patients aged 2-28 years old is shown in Table 1.…”