Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Br J Hosp Med (Lond). 2021 Apr 2;82(4):1-7. doi: 10.12968/hmed.2020.0659. Epub 2021 Apr 27.
BACKGROUND/AIMS: Knowledge of the aetiologies of large bowel perforation are fundamental to its management. Stercoral perforation is a rare cause associated with high mortality. Owing to the paucity of coverage of this condition in the literature, this review raises awareness of stercoral perforation among clinicians.
A literature search of PubMed, Embase, MEDLINE, CINAHL, Ovid and Cochrane was performed. Key search terms included 'stercoral, perforation', 'perforated', 'perforat*' and 'stercoral perforation'. Only literature published between December 2011 and July 2020 was included to avoid duplication.
Twenty-nine papers were obtained giving an overall cohort of 58 patients. The median age was 58 years (range 2-83 years) and 72.4% (=42) were female. Constipation was reported in 69% (=40) and 20.7% (=12) reported chronic opioid use. A computed tomography scan was performed in 94.8% (=55) of cases and typically a Hartmann's procedure (=40, 72.2%) was performed. The mortality rate was 17.2% (=10).
The median age of patients with stercoral perforation has decreased from that found in previous studies and the mortality rate has improved. Chronic opioid users have also emerged as an important cohort. Early recognition, diligent decision making and focused perioperative care form the backbone of the definitive management of stercoral perforation.
背景/目的：了解大肠穿孔的病因对于其治疗至关重要。粪石穿孔是一种罕见的病因，死亡率较高。由于文献中对此病症的报道很少，因此本文旨在提高临床医生对粪石穿孔的认识。
对 PubMed、Embase、MEDLINE、CINAHL、Ovid 和 Cochrane 进行文献检索。主要检索词包括“粪石、穿孔”、“穿孔”、“perforat*”和“粪石穿孔”。仅纳入 2011 年 12 月至 2020 年 7 月发表的文献，以避免重复。
共获得 29 篇文献，共纳入 58 例患者。患者的中位年龄为 58 岁（范围 2-83 岁），72.4%（42 例）为女性。69%（40 例）的患者报告有便秘，20.7%（12 例）报告有慢性阿片类药物使用史。94.8%（55 例）的患者进行了计算机断层扫描，通常采用 Hartmann 手术（40 例，72.2%）。死亡率为 17.2%（10 例）。
与以往的研究相比，粪石穿孔患者的中位年龄有所下降，死亡率有所改善。慢性阿片类药物使用者也成为一个重要的群体。早期识别、谨慎决策和有针对性的围手术期护理是粪石穿孔确定性治疗的基础。
