Stercoral colitis

Background

Normal inner diameters of colon sections.

• 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
• Mortality rate between 32-59% if associated with perforation

Differential Diagnosis

Constipation

• Behavioral-related
  • Lack of exercise
  • Diet-related
• Fecal impaction
  • Stercoral colitis
• Ileus from surgical abdomen
  • Appendicitis
  • Diverticulitis
• Bowel obstruction
  • Small bowel obstruction
  • Large bowel obstruction
    • Ogilvie's syndrome
  • Malignant bowel obstruction
  • Specific causes: tumor, stricture, hernia, adhesion, volvulus
• 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

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