Stercoral colitis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Diameters of the large intestine.png|thumb|Normal inner diameters of colon sections.]] | |||
*Inflammatory [[colitis]] related to increased intraluminal pressure from [[fecal impaction|impacted fecal material]] in the colon | *Inflammatory [[colitis]] related to increased intraluminal pressure from [[fecal impaction|impacted fecal material]] in the colon | ||
**Pressure may cause ulceration and ultimately perforation | **Pressure from fecaloma or colonic distention may cause ulceration/necrosis and ultimately perforation | ||
*Rare condition | *Rare condition, but with high mortality rate (32-59%) when complicated by perforation<ref>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/</ref> | ||
*Primarily in elderly, nursing home or young patients with neurological impairment, chronic opioid use | *Primarily in elderly, nursing home, or young patients with neurological impairment, chronic opioid use | ||
==Clinical Features== | ==Clinical Features== | ||
*History of chronic [[constipation]] | *History of chronic [[constipation]] and/or [[fecal impaction]] | ||
*May be asymptomatic or have only mild [[abdominal pain]] at initial stages | *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<ref>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.</ref> | |||
*Abdominal pain/tenderness, distension, [[vomiting]] are most common symptoms <ref> 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 </ref> | *Abdominal pain/tenderness, distension, [[vomiting]] are most common symptoms <ref> 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 </ref> | ||
* | *Rectal bleeding | ||
*Symptoms and signs of peritonitis or shock | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==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 <ref> Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193. </ref> | [[File:179e455f29abdcd110a7e67428587e big gallery.jpg|thumb|Abdominal CT showing stercoral colitis with preformation (free air shown by arrows).]] | ||
===Work up=== | |||
*Digital rectal exam | |||
*Abdominal panel | |||
**CBC | |||
**Chemistry ([[hypokalemia]] or [[hypercalcemia]]) | |||
**LFTs + lipase | |||
**Consider coagulation studies (PT, PTT, INR), as a marker of liver function | |||
*[[Lactate]] | |||
*Consider preoperative labs including type & screen | |||
*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 <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== | ||
*Surgical consult | *Fluid resuscitation | ||
*May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas) if no evidence of bowel perforation or ischemia | *Broad spectrum [[antibiotics]] covering intra-abdominal flora (e.g., [[ceftriaxone]] + [[metronidazole]]) | ||
*Surgical consult, NPO | |||
**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia | |||
==Disposition== | ==Disposition== | ||
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==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] [[Category:Surgery]] | [[Category:GI]] [[Category:Surgery]] | ||
Latest revision as of 21:35, 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
- Consider coagulation studies (PT, PTT, INR), as a marker of liver function
- Lactate
- Consider preoperative labs including type & screen
- 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
- Fluid resuscitation
- Broad spectrum antibiotics covering intra-abdominal flora (e.g., ceftriaxone + metronidazole)
- Surgical consult, NPO
- May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia
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.