Stercoral colitis mimicking appendicitis

Abstract

BackgroundStercoral colitis is an inflammatory process involving the colonic wall related to fecal impaction. This rare condition is associated with high morbidity-mortality.FindingsWe report a case of a 78-year-old woman with a history of dementia under clozapine who presented a clinical and sonographic presentation of acute appendicitis. The worsening of her clinical condition prompted us to review our diagnosis and modify our approach using the CT scan which was consistent with stercoral colitis. This report concerns an atypical presentation of this condition.ConclusionsThe present case highlights the ability of severe forms of fecal impaction to precipitate very rare and life-threatening complications like stercoral colitis. It also points the importance of including stercoral colitis in the differential diagnosis of acute appendicitis in altered patients under anticholenergic drugs and the critical role of the CT scan as a crucial radiologic adjunct.

Six Cases of Perforated Appendicitis During Clozapine Treatment

“…A PubMed search with the terms clozapine and appendicitis, with no language or date limits, revealed only 1 similar case that was classified as stercoral colitis mimicking appendicitis. 2 In our cases, histologic examination did not provide evidence for mechanisms other than bacterial inflammation. In addition to the epidemiologic estimation, pathophysiologic considerations add to the possibility of a side effect attributable to clozapine.…”

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] . When the NPSC cases were stratified for sepsis, a total of 4 cases with 2 fatalities was yielded [24] , [25] , [26] , [27] .…”

“…There were 9 cases total of NPSC with 4 fatalities [4] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] . When the NPSC cases were stratified for sepsis, a total of 4 cases with 2 fatalities was yielded [24] , [25] , [26] , [27] .…”

“…When combining the cases of NPSC with sepsis from the case series published by Saksonov et al and Cheng Wu et al, with individual case reports [24] , [25] , [26] , [27] there was a total of 11 cases. Our case would make the 12th such case in the literature.…”

Clozapine-induced stercoral colitis: a surgical perspective

“…The case described herein is notable for the short history, with only very mild initial symptoms of abdominal pain and constipation. The difficulty in diagnosing this condition is also emphasised by a recent report of a 78-year-old patient treated with clozapine presenting with what appeared to be appendicitis before the diagnosis of stercoral colitis was subsequently made at surgery 20…”