Louisiana State University Health Sciences Center New Orleans, LA, United States
Scott R. Piechocki, MD1, Mary C. Marshall, MD2, Jack A. Di Palma, MD2 1Louisiana State University Health Sciences Center, New Orleans, LA; 2University of South Alabama, Mobile, AL
Introduction: Stercoral colitis is a rare complication of fecal impaction that can lead to severe morbidity or mortality if not promptly managed. Fecal impaction and chronic constipation are more common in the elderly, psychiatric patients, and chronic opioid users. Stercoral colitis occurs when fecal impaction leads to increased colonic luminal pressure, distention, and the development of fecalomas. Fecalomas in the setting of persistent coprostasis leads to compression on the colonic wall and vasculature. This impaired blood supply can cause focal ulceration and ultimately evolve into regional necrosis. Given the vague presentation, CT scan is the most sensitive tool for diagnosis. Here, we present a patient with a fatal case of stercoral colitis.
Case Description/Methods: An 80 year old Caucasian female presented to the emergency department due to a syncopal episode following a two day history of nausea, vomiting, and decreased oral intake. The patient also reported a two week history of urinary retention for which she had sought care at an outside hospital prior to this admission. She was found to have lymphocytosis, hypovolemic hyponatremia, and hypokalemia. Her physical exam was remarkable for dry oral mucosa. A CT abdomen pelvis showed a large stool burden throughout the colon, dilatation of the rectum and perirectal edema. The patient was treated with an enema that resulted in small bowel movements. On day two of hospitalization, the patient became hypotensive. A normal saline bolus was given and she had an episode of fecal emesis. She was intubated due to hypoxic respiratory failure from aspiration, and transferred to the ICU. Repeat imaging and labs showed worsening conditions. The patient’s family decided to withdraw care on day three of hospitalization and she unfortunately succumbed to her illness.
Discussion: This case highlights the vague presentation and importance of early identification and management of stercoral colitis. Due to the demographic of affected patients, history may be hard to obtain and the vague presentation may impede a timely diagnosis. Delay of recognition and management can lead to perforation, sepsis, peritonitis, and aspiration of fecal matter. As prompt intervention is imperative to avoid dire complications, healthcare providers should familiarize themselves with the demographics of susceptible patients, unreliability of physical exam, value of CT scan in diagnosis, and management options.
Figure: Dilated rectum with large stool burden and perirectal edema
Disclosures: Scott Piechocki indicated no relevant financial relationships. Mary Marshall indicated no relevant financial relationships. Jack Di Palma indicated no relevant financial relationships.
Scott R. Piechocki, MD1, Mary C. Marshall, MD2, Jack A. Di Palma, MD2. P1289 - A Fatal Case of Stercoral Colitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
