Thursday, 8 September 2016

Stercoral Colitis Associated with Colon Perforation

A 68 year-old woman presented with lower abdominal pain for three days and constipation for 10 days. The patient had a history of end-stage renal disease under regular hemodialysis, and coronary artery disease with antiplatelet drug. Physical examination was unremarkable except rebounding tenderness over lower abdomen. Blood tests showed bandemia 9% in white blood cell counts and elevated C-reactive protein (>250 mg/L, reference value, <3 mg/L).

Stercoral Colitis
Abdominal radiography showed sign of retroperitoneal air - the presence of air outlining the psoas muscle (Figure 1, arrow) and one gas-contenting abscess at left lower quadrant abdomen. Computed tomography (CT) of the abdomen revealed a large amount of fecaloma within sigmoid colon with wall thickening and pericolic fat stranding, and extravasation of stool material at left pelvic region (Figure 2, arrow), and pneumoretroperitoneum extending from the lower abdominal abscess.


Under the impression of stercoral colitis associated sigmoid colon perforation, emergent exploratory laparotomy was performed. One 1.6*1 cm perforation of sigmoid colon with abscess formation was found. The pathologic report of colon resection specimen shows aggregates of hemosiderin-laden macrophages in colonic mucosa with focal transmural necrosis. The post-operation course was smooth, and the patient was discharge uneventfully twelve days later.

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