Prognostic Factors of Patients with Stercoral Perforation of the Colon

Abstract

Background/Aims: The incidence of stercoral perforation of the colon (SPC) is expected to rise, given the increased life expectancy and the aging population. On the other hand, the prognostic factors of mortality after surgery for SPC remain unclear. This study examined the prognostic factors of patients with SPC after surgery. Methods: The medical records of 145 patients who underwent surgery for colonic perforation between April 2010 and May 2019 were reviewed retrospectively. In 145 patients, 22 patients who underwent SPC surgery were categorized into the following two groups according to in-hospital survival after surgery: alive (group A, n=15) and dead (group B, n=7). Results: In all enrolled patients, the mean age was 75.7±9.0 years, with a female predominance (female patients, n=19, 86.4%). Sixteen patients (72.7%) had chronic constipation with medications, and five patients (22.7%) were bedridden. The rate of preoperative bedridden status was significantly higher in group B than group A (6.7% vs. 57.1%; p=0.021). Univariate analysis revealed immobility, a sequential organ failure assessment (SOFA) score, and lactate levels of more than 2.0 mmol/L to be factors associated with increased mortality rates in the postoperative period. Multivariate analysis revealed abnormal lactate levels to be the only factor related to mortality (hazard ratio 16.50, 95% CI 1.48-183.07, p=0.022). Conclusions: Preoperative abnormal serum lactate levels may be a risk factor for mortality after surgery in patients with stercoral perforation. Further research will be needed to identify the postoperative prognostic SPC factors.

Small Bowel Evisceration Through a Perforated Stercoral Ulcer

“…Risk factors of developing stercoral ulcers include old age, hospitalization, infections, multiple medications, immobility, and inherent colonic dysmotility all of which can lead to chronic constipation. 3 In this case, the patient had chronic constipation likely due to Prader-Willi syndrome, which is associated with increased gastrointestinal transit time, as well as decreased muscle tone.…”

Spontaneous Cecal Perforation During Pregnancy

“…This is frequently seen in elderly patients with a history of constipation with a mean age of onset greater than 65 [ 1 ]. The proposed diagnostic criteria for feculent colonic perforation are as follows: a rounded shape exceeding 1 cm in diameter; fecaloma present diffusely throughout the colon and in the abdominal cavity through the perforation; ischemia and necrosis of the colonic mucosa leading to a chronic inflammatory response visible around the perforation site microscopically; and exclusion of injury, obstructions, tumors, or diverticulosis [ 2 ]. In contrast, idiopathic perforations appear as linear tears with clear edges and normal-appearing mucosa both macroscopically and microscopically [ 3 ].…”

Acute Constipation and A Stercoral Perforation: A Case Report

“…Outside of sex, none of these risk factors were present in our case. 6 , 4 , 8 There has been some improvement in diagnosis as evidenced by a slight increase in incidence of stercoral perforation from 2.3% to 3.2%. 9 Clinical presentation of a stercoral perforation is usually characterized as an acute onset of diffuse abdominal pain, diffuse peritonitis, or pneumoperitoneum.…”

“… 3 It is unclear which gender and age division is more susceptible to the development of stercoral perforations. Some studies estimate the mean age to be 75.7 ± 9.0 years with a female predominance 4 while others postulate that the mean age has decreased over recent years with an emphasis on higher occurrences in opioid users. 2 In the wrong patient, this can ultimately lead to their demise with reported cases of mortalities following late diagnosis of stercoral perforation.…”