Stercoral colitis: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:179e455f29abdcd110a7e67428587e big gallery.jpg|thumb|Abdominal CT showing stercoral colitis with preformation (free air shown by arrows).]] | [[File:179e455f29abdcd110a7e67428587e big gallery.jpg|thumb|Abdominal CT showing stercoral colitis with preformation (free air shown by arrows).]] | ||
*CBC | ===Work up=== | ||
* | *Digital rectal exam | ||
* | *Abdominal panel | ||
* | **CBC | ||
**Chemistry ([[hypokalemia]] or [[hypercalcemia]]) | |||
**LFTs + lipase | |||
*[[Lactate]] | |||
*Consider preoperative labs including type & screen or coags | *Consider preoperative labs including type & screen or coags | ||
*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 <ref> Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193. </ref> | *Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]] | ||
**Fecolomas may be visualized as radiopaque masses | *CT abdomen/pelvis with IV contrast | ||
**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 <ref> Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193. </ref> | |||
**Fecolomas may be visualized as radiopaque masses | |||
===Diagnosis=== | |||
*Diagnosis is typically made on CT | |||
==Management== | ==Management== | ||
Revision as of 18:09, 14 February 2024
Background
- Inflammatory colitis related to increased intraluminal pressure from impacted fecal material in the colon
- Pressure from fecaloma or colonic distention may cause ulceration/necrosis and ultimately perforation
- Rare condition, but with high mortality rate (32-59%) when complicated by perforation[1]
- Primarily in elderly, nursing home, or young patients with neurological impairment, chronic opioid use
Clinical Features
- History of chronic constipation and/or fecal impaction
- May be asymptomatic or have only mild abdominal pain at initial stages
- Maintain a high index of suspicion; a recent review shows lack of abdominal pain in as much as 62% of cases[2]
- Abdominal pain/tenderness, distension, vomiting are most common symptoms [3]
- Rectal bleeding
- Symptoms and signs of peritonitis or shock
Differential Diagnosis
Constipation
- Behavioral-related
- Lack of exercise
- Diet-related
- Fecal impaction
- Ileus from surgical abdomen
- Bowel obstruction
- Small bowel obstruction
- Large bowel obstruction
- Malignant bowel obstruction
- Specific causes: tumor, stricture, hernia, adhesion, volvulus
- Painful anorectal disorders (e.g. anal fissure, hemorrhoids)
- Medical causes
- Hypothyroidism
- Electrolytes
- Hypokalemia
- Medication-related
- Opiods, antipsychotics, anticholinergics, antacid, antihistamines
- Constipation (peds)
Evaluation
Work up
- Digital rectal exam
- Abdominal panel
- CBC
- Chemistry (hypokalemia or hypercalcemia)
- LFTs + lipase
- Lactate
- Consider preoperative labs including type & screen or coags
- Consider TSH if concern for hypothyroid related constipation
- CT abdomen/pelvis with IV contrast
- 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 [4]
- Fecolomas may be visualized as radiopaque masses
Diagnosis
- Diagnosis is typically made on CT
Management
- Surgical consult, NPO
- May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas) if no evidence of bowel perforation or ischemia
- Fluid resuscitation
- Consider broad spectrum antibiotics
- Initiate bowel regimen
Disposition
- Admit
See Also
External Links
References
- ↑ Morano C, Sharman T. Stercoral Colitis. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560608/
- ↑ Keim AA, Campbell RL, Mullan AF, McElhinny ML, Monas J, Finch AS, Mathis KL, Lindor RA. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Ann Emerg Med. 2023 Jul;82(1):37-46. doi: 10.1016/j.annemergmed.2023.02.003. Epub 2023 Mar 23. PMID: 36966044.
- ↑ 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.