Yu Hung-Chun, Pu Ta-Wei, Kang Jung-Cheng, Chen Chao-Yang, Hu Je-Ming, Su Ruei-Yu
Department of Surgery, Taichung Armed Forces General Hospital, Taichung 411228, Taiwan.
Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
World J Gastrointest Surg. 2024 Apr 27;16(4):1189-1194. doi: 10.4240/wjgs.v16.i4.1189.
With less than 90 reported cases to date, stercoral perforation of the colon is a rare occurrence. Stercoral ulceration is thought to occur due to ischemic pressure necrosis of the bowel wall, which is caused by the presence of a stercoraceous mass. To underscore this urgent surgical situation concerning clinical presentation, surgical treatment, and results, we present the case of a 66-year-old man with a stercoral perforation.
A 66-year-old man with a history of hypertension, hyperlipidemia, and gout presented at the emergency department with lower abdominal pain and a low-grade fever lasting for a few hours. Abdominal computed tomography indicated a suspected bezoar (approximately 7.6 cm) in the dilated cecum, accompanied by pericolic fat stranding, mild proximal dilatation of the ileum, pneumoperitoneum, and minimal ascites. Intraoperatively, feculent peritonitis with isolated cecal perforation were observed. Consequently, a right hemicolectomy with peritoneal lavage was performed. A histopathological examination supported the intraoperative findings.
In stercoral perforations, a diagnosis should be diligently pursued, especially in older adults, and prompt surgical intervention should be implemented.
迄今为止，报道的结肠粪性穿孔病例不足90例，是一种罕见的病症。粪性溃疡被认为是由于存在粪块导致肠壁缺血性压迫坏死而发生的。为强调这种关于临床表现、手术治疗及结果的紧急手术情况，我们报告一例66岁男性粪性穿孔病例。
一名有高血压、高脂血症和痛风病史的66岁男性因下腹部疼痛和低热数小时就诊于急诊科。腹部计算机断层扫描显示扩张的盲肠内疑似有粪石（约7.6厘米），伴有结肠周围脂肪条索状影、回肠近端轻度扩张、气腹和少量腹水。术中观察到有粪性腹膜炎伴孤立性盲肠穿孔。因此，实施了右半结肠切除术并进行了腹腔灌洗。组织病理学检查支持术中发现。
在粪性穿孔中，应积极进行诊断，尤其是在老年人中，并且应及时实施手术干预。
