0418 stercoral colitis
TRANSCRIPT
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Case presentation
2008-04-18R1 이진영
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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