Stercoral Perforation of Sigmoid Colon in Systemic Lupus Erythematosus: A Rare Cause of Peritonitis

Abstract

Stercoral perforation (SP) is a rare cause of peritonitis. It is caused by pressure necrosis of the colonic wall by fecaloma. SP is a lethal condition that is associated with high morbidity and mortality, therefore early diagnosis and treatment are of paramount importance. Herein, we describe a case of SP in a systemic lupus erythematosus (SLE) patient. A 44-year-old female, known case of SLE, presented with severe abdominal pain, fever, and hypotension. CT scan showed features of perforated sigmoid. The patient underwent exploratory laparotomy which revealed perforation of sigmoid, fecalomas in the peritoneal cavity, and colon loaded with fecal matter. The patient underwent Hartmann's operation with successful control of her intra-abdominal sepsis. Her postoperative course was complicated by SLE flare and wound dehiscence which was probably due to long term steroid use. Even though SP is rare, it carries a worse prognosis especially if the patients are immunocompromised. The key to successfully manage such cases is early diagnosis, aggressive resuscitation, antibiotics, and prompt surgical intervention. A multidisciplinary approach is often helpful in such cases.

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

“…By exploring the published English literature (PubMed search from 1965 through August 2020), we found only two cases of stercoral colitis in patients with SLE ( 22 , 23 ). In one case report, a 45-year-old woman with SLE presented with epigastric pain for 12 hours, and the author believed that the cause of stercoral perforation was related to NSAIDs ( 22 ).…”

“…In one case report, a 45-year-old woman with SLE presented with epigastric pain for 12 hours, and the author believed that the cause of stercoral perforation was related to NSAIDs ( 22 ). Another case report involved a 44-year-old SLE woman presenting with stercoral perforation due to long-term steroid use ( 23 ). Our patient is the first pediatric-onset (onset age at the 8) lupus case complicated by stercoral colitis without a disease flare or NSAID medication use.…”

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

“…Upon exploring the published English literature (PubMed search from 1965 through August 2020), only two cases of stercoral colitis in patients with SLE have been reported [24,25], while constipation is demonstrated in 6% of lupus patients [26]. In one case report, a 45-year-old woman with SLE presented with epigastric pain for 12 hours.…”

“…The author thought that the cause of stercoral perforation in the sigmoid colon was possibly related to nonsteroidal anti-in ammatory drug (NSAID) use [24]. The other case report addressed a 44-year-old female presenting with stercoral perforation but a complication of SLE attributed to long-term steroid use who had a worse prognosis 25 . In addition, our patient is the rst pediatric-onset lupus patient complicated by stercoral colitis without a disease are, and several causes were postulated.…”

Steroid Induced Perforation of Colon in Systemic Lupus Erythematosus

“…Another proposed mechanism is steroid use in SLE, resulting in an immunocompromised state, which leads to Cytomegalovirus infection and subsequent ulceration and perforation of the bowel wall [3]. Stercoral perforation has also been reported in several studies [4]. Lupus enteritis can progress to intestinal necrosis and perforation.…”