Reategui Cesar, Grubbs Derek
Department of Surgery, Missouri Delta Medical Center, Sikeston, MO, USA.
Department of Surgery, Missouri Delta Medical Center, Sikeston, MO, USA.
Int J Surg Case Rep. 2022 Sep;98:107528. doi: 10.1016/j.ijscr.2022.107528. Epub 2022 Aug 17.
Stercoral colitis is an inflammatory condition caused by fecal impaction; it involves the colonic or rectal wall. It occurs most commonly in nursing home patients, chronic opioid users, and patients with mental impairment.
We present the case of a 36-year-old, obese, African American male with a history of intellectual disability, bipolar disorder, and chronic constipation. Patient presented to the emergency room after an episode of syncope, confusion, 24-hour abdominal pain, nausea, and vomiting. On admission to the ED the patient was found to be in sepsis; within 4 h he developed septic shock. CT scan of the abdomen showed impacted fecal matter in a significantly distended left and sigmoid colon. This was associated with colitis, extensive fat stranding and free fluid, without pneumoperitoneum. The patient was taken to the operating room for exploration where he underwent an extended left colectomy and Hartmann's procedure. Pathology showed acute focal colitis with transmural necrosis. There were no signs of perforation or inflammatory bowel disease. The patient recovered and was discharged home on post-operative day 8. Upon follow up on post-operative day 22, he was doing well.
This case illustrates a very rare and challenging scenario. Complications of stercoral colitis include: stercoral ulcer, perforation, ischemic colitis, sepsis and death. Peritonitis, sepsis and bowel necrosis without perforation is extremely rare with very few cases reported in the literature. Colectomy with diversion is the mainstay of therapy.
It is of paramount importance for ED providers and general surgeons to be aware of this condition. It presents a diagnostic challenge and carries an elevated mortality. Elderly patients on chronic opioids and those with mental impairment are at a higher risk.
粪性结肠炎是一种由粪块嵌塞引起的炎症性疾病，累及结肠或直肠壁。它最常见于疗养院患者、慢性阿片类药物使用者以及精神障碍患者。
我们报告一例36岁肥胖的非裔美国男性病例，该患者有智力残疾、双相情感障碍和慢性便秘病史。患者在一次晕厥、意识模糊、24小时腹痛、恶心和呕吐发作后就诊于急诊室。急诊入院时发现患者处于脓毒症状态；4小时内发展为感染性休克。腹部CT扫描显示左半结肠和乙状结肠明显扩张，内有粪块嵌塞。这与结肠炎、广泛的脂肪条索和游离液体有关，无气腹。患者被送往手术室进行探查，接受了扩大左半结肠切除术和哈特曼手术。病理显示急性局灶性结肠炎伴透壁坏死。无穿孔或炎症性肠病的迹象。患者康复，术后第8天出院。术后第22天随访时，他情况良好。
本病例说明了一种非常罕见且具有挑战性的情况。粪性结肠炎的并发症包括：粪性溃疡、穿孔、缺血性结肠炎、脓毒症和死亡。无穿孔的腹膜炎、脓毒症和肠坏死极为罕见，文献报道的病例很少。结肠切除并改道是主要的治疗方法。
急诊医生和普通外科医生了解这种疾病至关重要。它带来了诊断挑战，且死亡率较高。长期使用阿片类药物的老年患者和精神障碍患者风险更高。
