Keywords
Intestinal obstruction
Stercoral perforation
Abdominal Pain
Fecal impaction
Constipation
How to Cite
Abstract
Stercoral perforation is a rupture of the colon associated with fecal impaction, rare and lethal, with fewer than 200 cases reported globally. It predominates in the geriatric population and primarily manifests with chronic constipation. The objective of the article is to present the case of a mid-adult woman with a history of chronic constipation and diverticular disease, who was admitted to the emergency room with a one-week history of generalized abdominal pain, progressing to a rigid abdomen, altered consciousness, and tachypnea. Abdominal sepsis was suspected, leading to an emergency laparotomy. This revealed fecal pelvic peritonitis originating from a sigmoid fecaloma with a 12 cm stercoral perforation, managed with sigmoidectomy, broad-spectrum antibiotic therapy, and peritoneal lavage. The patient had a favorable outcome and was discharged. This surgically and diagnostically challenging case highlights the complexity of an uncommon pathology in an atypical age group.
References
Berry J. Dilatation and rupture of sigmoid flexure short report. Brit Med J. 1894;1:301.
Tokunaga Y, Hata K, Nishitai R, Kaganoi J, Nanbu H, Ohsumi K. Spontaneous perforation of the rectum with possible stercoral etiology: report of a case and review of the literature. Surg Today. 1998;28(9):937-939.
Ryu CG, Kim P, Cho MJ, Shin M, Jung EJ. Clinical analysis of stercoral perforation without mortality. Dig Surg. 2017;34(3):253–259.
De Lillo AR, Rose S. Functional bowel disorders in the geriatric patient: constipation, fecal impaction, and fecal incontinence. Am J Gastroenterol. 2000;95(4):901-905.
Poitras R, Warren DL, Oyogoa S. Opioid drugs and stercoral perforation of the colon: Case report and review of literature. Int J Surg Case Rep. 2018;42:94–97.
Hakami M, Mosavy SH, Tadaiion A. Stercoral perforation of the sigmoid colon: report of two cases. Dis Colon Rectum 1975; 18:(6) 512–513.
Lundy JB, Gadacz TR. Massive fecal impaction presenting with megarectum and perforation of a stercoral ulcer at the rectosigmoid junction. South Med J. 2006; 99:(5) 525–527.
Gekas P, Schuster MM. Stercoral perforation of the colon: case report and review of the literature. Gastroenterology. 1981 May;80(5 pt 1):1054-1058.
Mounir B, Oussama L, Zineb AEA, Abdelilah EB, Khalid EH, Fatima-Zahra B, Abdelaaziz F. Stercoral perforation of the colon: a mortal consequence of chronic constipation in the elderly (a case report). Pan Afr Med J. 2021;38:48.
Heffernan C, Pachter HL, Megibow AJ, Macari M. Stercoral colitis leading to fatal peritonitis: CT findings. AJR Am J Roentgenol. 2005;184(4):1189- 1193.
Kwag SJ, Choi SK, Park JH, Jung EJ, Jung CY, Jung SH, et al. A Stercoral perforation of the rectum. Ann Coloproctol. 2013;29(2):77.
Maurer CA, Renzulli P, Mazzucchelli L et al. Use of accurate diagnostic criteria may increase incidence of stercoral perforation of the colon. Dis Colon Rectum. 2000; 43(7):991-998.
Kumar P, Pearce O, Higginson A. Imaging manifestations of faecal impaction and stercoral perforation. Clin Radiol. 2011;66(1):83-88.
Huang WS, Wang CS, Hsieh CC, Lin PY, Chin CC, Wang JY. Management of patient with stercoral perforation of the sigmoid colon:report of five cases. World J Gastroenterol. 2006;12(3):500- 503.
Carter DC, Kirkpatrick JR. Stercoral perforation of the sigmoid colon. Br J Surg. 1973;60(1):61-63.
Read NW, Abouzekry L, Read MG, Howell P, Ottewell D, Donnelly TC. Anorectal function in elderly patients with fecal impaction. Gastroenterology 1985;89(5):959-966.
Forootan M, Bagheri N, Darvishi M. Chronic constipation: A review of literature. Medicine (Baltimore). 2018;97(20):e10631.
Serpell JW, Nicholls RJ. Stercoral perforation of the colon. Br J Surg 1990; 77(12):1325-1329.
Chakravartty S, Chang A, Nunoo-Mensah J. A systematic review of stercoral perforation. Colorectal Dis. 2013;15(8):930-935.
Ünal E, Onur MR, Balcı S, Görmez A, Akpınar E, Böge M. Stercoral colitis: diagnostic value of CT findings. Diagn Interv Radiol. 2017;23(1):5-9.
Mandell GL, Bennett JE, Dolin R. Mandell: Principles and Practice of Infectious Diseases. 5th ed. Churchill Livingstone Inc:Estados Unidos;2000.
Patel VG, Kalakuntla V, Fortson JK, Weaver WL, Joel MD, Hammami A. Stercoral perforation of the sigmoid colon: report of a rare case and its possible association with nonsteroidal antiinflammatory drugs. Am Surg. 2002;68(1):62–64.
Guyton DP, Evans D, Schreiber H. Stercoral perforation of the colon. Concepts of operative management. Am Surg. 1985;51(9):520–522.
Tsai AY, Chao ST, Yang HM. Stercoral perforation of the sigmoid colon. International J Gerontology 2008 2(4):233-235.
Maull KI, Kinning WK, Kay S. Stercoral ulceration. Am Surg. 1982;48(1):20–24.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Médicas UIS