Management of patients with stercoral perforation of the sigmoid colon: Report of five cases

Abstract

To our knowledge, stercoral perforation of the colon is rarely seen with fewer than 90 cases reported in the literature till date. We explored the principles of management to prevent impending mortality in five patients with this condition. Five patients, two males and three females, whose median age was 64 years, had sustained stercoral perforation of the sigmoid colon. Chronic constipation was the common symptom among these patients. Three patients underwent a Hartmannos procedure and another two were treated with segmental colectomy with anastomosis and diverting colostomy. There was one surgical mortality and the other patients had an uneventful hospital stay. Timely intervention to prevent and/or treat any associated sepsis along with extensive peritoneal lavage and surgical intervention to remove diseased colonic tissue at the primary stercoral ulceration site coupled with aggressive therapy for peritonitis are key treatment modalities in salvaging patients presenting with stercoral perforation of the colon.

Stercoral colitis: diagnostic value of CT findings

“…Limited surgeries may be associated with inferior clinical outcomes, since residual affected colonic segments carry the risk of recurrent perforations. In the literature, several studies suggest that in patients with stercoral perforation of the colon optimal outcome can be achieved by resection of the whole affected colon segment with an end colostomy (mucous fistula/Hartmann's procedure) (7)(8)(9). Our results tend to agree with these studies.…”

Chronic Constipation: An Evidence-Based Review

“…79 It is not a common condition; fewer than 90 cases have been reported in the medical literature from 1894 to 2006. 80 …”

Perforación estercorácea de colon

“…La constipación severa parece ser la causa de la formación de fecalomas pétreos que mantienen una presión permanente sobre las paredes del colon (1)(2)(3)(4)(5). Las úlceras colónicas por fecaloma no siempre acaban en perforación pero sí la presencia de varios fecalomas implica la posibilidad de varias úlceras y perforaciones como en nuestra paciente.…”

“…Por este motivo se acepta la realización de la intervención de Hartmann para la resolución de cuadro. Algunos autores han propuesto la colonoscopia intraoperatoria para revisar la integridad del colon restante y evitar así una futura perforación inadvertida debida a una úlcera ya existente (2). Un pronóstico favorable viene dado por un manejo y tratamiento rápido de la sepsis, la resección del tejido necrótico así como los lavados peritoneales.…”