Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ.
Department of Emergency Medicine, Mayo Clinic, Rochester, MN.
Ann Emerg Med. 2023 Jul;82(1):37-46. doi: 10.1016/j.annemergmed.2023.02.003. Epub 2023 Mar 23.
Stercoral colitis is inflammation of the bowel wall caused by fecal impaction. Despite reported high morbidity and risk of perforation, little research assessing outcomes is available. This study characterizes the presentation, management, and outcomes of emergency department patients with stercoral colitis.
We performed a retrospective chart review of ED patients with stercoral colitis identified on computed tomography (CT) scan. Of 814, 522 visits to multiple EDs across the US, 269 met the inclusion criteria. Variables regarding patient presentation, management, and outcomes were extracted from electronic medical records. Results were analyzed with percentages and 95% confidence intervals (CIs).
Of 269 patients, the median age was 76 years. The most common chief concern was abdominal pain/distension (33.8%). However, abdominal pain was documented as absent in 62.1% of cases. The most common CT findings included fecal impaction (96.7%), bowel wall inflammation (72.9%), and fat stranding (48.3%). Eighty-four (31.2%) patients were discharged home from the ED, and over half of these (45/84, 53.6%) received no enema, laxatives, or disimpaction. Overall, 9 patients (3.3%, 95% CI 1.6% to 6.5%) required surgical management of a related complication within 3 months, 27 (10.0%, 95% CI 6.8% to 14.4%) returned to the ED within 72 hours, and 9 (3.3%, 95% CI 1.6% to 6.5%) died from a cause related to stercoral colitis within 3 months.
Patients with stercoral colitis often present in a nonspecific manner, and short-term mortality is substantial. In this study, most discharged patients did not receive recommended treatment. This represents the largest ED study of stercoral colitis and provides further evidence linking this diagnosis with adverse outcomes.
粪石性结肠炎是由粪便嵌塞引起的肠壁炎症。尽管据报道发病率和穿孔风险很高，但评估结果的研究很少。本研究描述了急诊科粪石性结肠炎患者的表现、治疗和结局。
我们对在美国多家急诊科进行 CT 扫描发现的粪石性结肠炎患者进行了回顾性图表审查。在 814 次就诊中，有 269 次符合纳入标准。从电子病历中提取患者表现、治疗和结局相关变量。结果以百分比和 95%置信区间（CI）表示。
在 269 例患者中，中位年龄为 76 岁。最常见的主要关注点是腹痛/腹胀（33.8%）。然而，62.1%的病例记录为无腹痛。最常见的 CT 发现包括粪便嵌塞（96.7%）、肠壁炎症（72.9%）和脂肪条纹（48.3%）。84 例（31.2%）患者从急诊科出院回家，其中超过一半（45/84，53.6%）未接受灌肠、泻药或松解。总体而言，9 例（3.3%，95%CI 1.6%至 6.5%）在 3 个月内需要手术治疗相关并发症，27 例（10.0%，95%CI 6.8%至 14.4%）在 72 小时内返回急诊科，9 例（3.3%，95%CI 1.6%至 6.5%）在 3 个月内因与粪石性结肠炎相关的原因死亡。
粪石性结肠炎患者常表现为非特异性，短期死亡率较高。在这项研究中，大多数出院患者未接受推荐治疗。这是对急诊科粪石性结肠炎最大的研究，进一步证明了这一诊断与不良结局之间存在关联。
