Stercoral colitis

Background

Inflammatory colitis related to increased intraluminal pressure from impacted fecal material in the colon
- Pressure may cause ulceration and ultimately perforation
Rare condition
Primarily in elderly, nursing home or young patients with neurological impairment, chronic opioid use

Clinical Features

History of chronic constipation
May be asymptomatic or have only mild abdominal pain at initial stages
Abdominal pain/tenderness, distension, vomiting are most common symptoms [1]

Differential Diagnosis

Constipation

Behavioral-related
- Lack of exercise
- Diet-related
Fecal impaction
Stercoral colitis
Diverticulitis
Bowel obstruction
- Small bowel obstruction
- Large bowel obstruction
  - Ogilvie's syndrome
- Malignant bowel obstruction
- Specific causes: tumor, stricture, hernia, adhesion, volvulus
- Malignant bowel obstruction
Painful anorectal disorders (e.g. anal fissure, hemorrhoids)
Medical causes
- Hypothyroidism
- Electrolytes
  - Hypomagnesia
  - Hypercalcemia
- Hypokalemia
Medication-related
- Opiods, antipsychotics, anticholinergics, antacid, antihistamines
Constipation (peds)

Evaluation

CT findings with focal thickening of colonic wall, stranding of pericolonic fat in segment showing fecal impaction, and presence of extraluminal bubbles of gas or abscess [2]

Management

Surgical consult
May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas) if no evidence of bowel perforation or ischemia

Disposition

Admit

See Also

Fecal impaction

External Links

References

Tsai TC, Chao CM. Stercoral colitis. Resuscitation & Intensive Care Med 2017;4:231-232 http://www.tsccm.org.tw/Magazine/Folder/a02_4/N20183712037_14-%BCv%B9%B3-10502-%BD%B2%A9v%A7%D3-231-232.pdf
Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193.

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