West Virginia University Morgantown, WV, United States
George B. Obeng, MD, Yala K. Reddy, MD, Asad Pervez, MD West Virginia University, Morgantown, WV
Introduction: 79 year old male presented to the hospital with two to three weeks of constipation with overflow diarrhea, and bright red blood per rectum. Patient's past medical history is significant for recurrent deep vein thrombosis, bilateral pulmonary embolism (on warfarin), and chronic constipation. On physical examination his abdomen was distended, tender, and tympanic. Labs were significant for elevated lactate, supratherapeutic INR (5.9) and hemoglobin of 15.1. Computerized tomography (CT) of abdomen and pelvis with contrast demonstrated large amounts of stool in the rectum with rectal wall thickening and pericolonic fat stranding concerning for stercoral colitis (Figure B).
Case Description/Methods: General surgery and Gastroenterology were consulted for concerns for ischemic bowel disease due to patient’s clinical presentation, history, and labs. Our general surgery team recommended conservative management. Patient received 2 units of fresh frozen plasma for reversal of his INR and underwent extensive bowel prep with goLYTELY. Colonoscopy demonstrated ulcers, erythematous mucosa, patches of dusky appearing colon in a contiguous fashion from rectum (relatively spared) to proximal sigmoid colon (Figure A). Pathology confirmed marked ulceration most consistent with ischemia.
Discussion: Stercoral colitis results when impacted fecal material leads to distention of the colon and fecaloma formation. It is believed that the colonic distention and fecaloma formation can lead to colonic vascular compromise and ulceration, which can subsequently cause several complications including focal pressure necrosis, colon perforation, sepsis, and ischemic colitis. Theses complications carry high mortality risk. Therefore, early diagnosis is imperative to minimize complications. Management of this rare condition depends on the clinical presentation of the patient such as presence or absence of peritonitis, bowel perforation, bowel ischemia, sepsis or in rare cases multiorgan failure.
Our patient presented with classical symptoms of stercoral colitis and was managed non-operatively. Patient was treated with multiple enemas and oral laxatives while under close monitoring. He was followed up in clinic two months post discharge and reported he was doing well and was trying to regulate the consistency of his bowel movements with the help of senna and MiraLax. Given our patients contiguous inflammation extended up to 40 cm from anal verge, he most likely had stercoral colitis complicated by ischemic colitis.
Figure: Figure A. Colonic ulcers, erythematous mucosa patches of dusky appearing colon in a contiguous fashion from rectum. Figure B. CT imaging of patient's suspected stercoral colitis.
Disclosures: George Obeng indicated no relevant financial relationships. Yala Reddy indicated no relevant financial relationships. Asad Pervez indicated no relevant financial relationships.
George B. Obeng, MD, Yala K. Reddy, MD, Asad Pervez, MD. P2307 - An Unusual Case of Colonic-Ulceration in a Patient with Constipation, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.