A Clinical Case Study and Review of the Literature on Stercoral Ulcer Perforation: An Uncommon but Deadly Culprit

Abstract

Stercoral ulcer perforation (SUP) was first described in 1894. Fewer than 150 cases have been reported in the literature. Historically, stercoral ulcers (SU) are mostly seen in older patients. However, in recent years younger patients have presented with this condition. Stercoral ulcers are caused by impacted feces, which result in loss of bowel wall integrity due to chronic pressure necrosis. This can lead to perforation and fecal peritonitis. It is a deadly but rare complication of chronic constipation. The case of a 78-year-old woman with a history of chronic constipation who presented to the emergency department (ED) with diffuse abdominal pain is described. Initial imaging studies revealed severe fecal impaction, most significant in the sigmoid and rectum. The patient was admitted for observation with serial abdominal exams, however, during the hospital course her clinical status deteriorated over a 12-hour period. Abdominal x-ray demonstrated free air under the diaphragm, and the patient was taken to the operating room (OR) for emergency exploratory laparotomy. Colorectal perforation was discovered and repaired. The patient tolerated the surgical intervention, but unfortunately died during the post-operative period. The patient’s history of chronic constipation, immobility, and opioid use for pain management after knee surgery most likely precipitated the stercoral ulceration and colonic perforation. In this study, a systematic review was conducted to assess the epidemiology, presentation, diagnosis, management, complications, and clinical implications associated with stercoral ulcers.