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Case presentation 2008-04-18 R1 이이이

0418 Stercoral Colitis

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Page 1: 0418 Stercoral Colitis

Case presentation

2008-04-18R1 이진영

Page 2: 0418 Stercoral Colitis

Case

이 @ 윤 66/M

Present illness

Chronic constipation hx.

최근 1 주일간 defecation 하지 못함 .

내원 3 일 전부터 epigastric discomfort.

내원 전일 abrupt periumbilical sever pain. Plain abdomen x-ray 상 free air 소견보여 transfer.

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4cm perforation at cecum, antemesenteric side No intraluminal lesion No tumorous lesion Cecum and ascending

colon adhesion with inflammatory appearance with dirty material.

Mucosa unremarkable

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Pathology

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Microscopic

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Stercoral colitis

Definition Inflammatory process of colonic wall

related to fecal impaction

Main causative factor : Severe chronic constipationelderly : often live in nursing homes

young patients : neurologically impaired

slow transit time : opiates, tricyclic antidepressants, tranquilizers

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Stercoral colitisMechanism

Conglomeration of dehydrated fecal material

→ Increased intraluminal pressure

→ Decreases blood supply

→ Ischemia → ulceration and perforation

NeverthelessStercoral ulceration does not always occur among constipation cases

Not every stercoral ulceration results in colon perforation.

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Stercoral colitis

Stercoral ulceration:

M/C in antimesenteric aspect of sigmoid colon hypoperfusive status

decreasing water content in the stool

narrow diameter

high intraluminal pressures

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CT FindingUncomplicated

fecal impaction

Stranding of pericolonic fat

Presence of -extraluminal bubbles of gas -abscess

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DiagnosisHystory of chronic constipation or fecal impaction Intraoperative findings

generalized peritonitis, colonic dilatationcolonic perforation size 1 cm or moreulcerations on the antimesenteric border If frank perforation occurs

-> fecal material within the peritoneal cavity in close proximity to the perforation site

Histologytransmural necrosisulcer margins sharply demarcated nonspecific inflammatory changes no additional colonic pathology is found

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TreatmentMost cases of uncomplicated stercoral colitis

successfully treated with disimpaction

Stercoral perforation broad spectrum antibiotics : initiated in all the patient

resection of the colon segment with an end colostomy

primary repair

Underlying disease Tx

Mortality related to stercoral perforation

: 30% to 55% , prompt exploration may decrease that rate

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Reference

Stercoral Colitis Leading to Fatal Peritonitis: CT Findings Cathleen et al.

AJR 2005; 184:1189-1193

Management of patients with stercoral perforation of the sigmoid colon: Report of five cases Wen-Shih Huang et al.

World J Gastroenterol  2006 January 21;12(3):500-503

Image of the Month—Perforated Stercoral Ulcer Arch Surg. 2007;142(1):98