Mission Disimpaction: Endoscopic Management of Stercoral Colitis in an Adolescent

Abstract

Stercoral colitis is a rare entity of inflammatory colitis with high morbidity and mortality attributable to colonic fecaloma impaction, often a result of chronic constipation. Despite demographic imbalance favoring elders, children hold comparative risk factors for chronic constipation. Suspicion for stercoral colitis is warranted in nearly every stage of life. Computerized tomography (CT) is diagnostic for stercoral colitis, where radiological findings correlate to high sensitivity and specificity. Difficulty exists discerning from other acute and chronic intestinal etiologies with overlapping nonspecific symptoms and laboratory markers. Management involves prompt risk assessment for perforation and immediate disimpaction to avoid ischemic injury, with endoscopic directed disimpaction standard of care for nonoperative measures. Our case describes stercoral colitis in an adolescent with contributive risk factors for fecaloma impaction and is one of the first adolescent case reports involving successful endoscopic management.

Stercoral colitis in the emergency department: a review of the literature

“…Pain control with opioids should be avoided to prevent worsening constipation [ 29 ]. Disimpaction can be done manually, medication-facilitated, or with endoscopic guidance; some publications support endoscopic disimpaction as the standard of care for nonoperative management of SC [ 1 , 39 ]. Given that SC can rapidly progress to perforation or sepsis, emergency clinicians should consider surgical consults and keep patients NPO even in seemingly uncomplicated cases.…”

“…If there is any concern for perforation, patients require immediate surgical evaluation and aggressive treatment with intravenous fluids and broad-spectrum antibiotics (covering gram-negative and anaerobic organisms), as sepsis-associated mortality risk increases substantially [ 39 ]. Operative intervention is a last resort reserved for patients with perforated SC or failure of conservative management [ 2 ].…”

Stercoral Colitis: An Unexpected Presentation in a Young Adolescent

“…A diagnosis of stercoral colitis in susceptible adult patients can be extremely difficult due to the multitude of nonspecific clinical symptoms, creating difficulty in differentiating between other similar presentations like inflammatory bowel disease or appendicitis. A majority of the presenting symptoms in stercoral colitis are vague complaints of abdominal pain, vomiting, nausea, distention anorexia, and constipation [ 3 ]. Images demonstrating distention of the affected colon segment greater than six centimeters with fecal material, wall thickening greater than three millimeters of the affected colon segment, and pericolonic fat tissue stranding can assist in a definitive diagnosis.…”

18F-FDG PET/CT Findings of a Patient With Stercoral Colitis

“…4 The diagnosis of this condition relies on CT, as clinical and laboratory findings are nonspecific. 5 The most significant CT findings are colon wall thickening, pericolonic fat stranding, and distention caused by fecaloma in the affected colon. 6,7 There might be additional findings if there is a perforation.…”

“…It is more common in elderly patients who are unable to express their complaints, have neurological diseases, are paralyzed, or are bedridden 4 . The diagnosis of this condition relies on CT, as clinical and laboratory findings are nonspecific 5 . The most significant CT findings are colon wall thickening, pericolonic fat stranding, and distention caused by fecaloma in the affected colon 6,7 .…”