Stercoral Colitis: A feared complication of a common complain.

Abstract

Stercoral colitis is a rare condition that occurs secondary to the impaction of fecal matter in the colon, leading to distention, bowel wall edema, ulceration, ischemic colitis and ultimately, bowel perforation. Most cases are seen in elderly patients with dementia, chronic opioid users, and patient with neuropsychiatric conditions. Here we present a case of a patient with multiple comorbidities who developed Stercoral colitis. A 52-year-old female with medical history of Diabetes Mellitus, Hypertension, Chronic Kidney Disease, Bipolar Disorder, on methadone for chronic opioid use disorder that was receiving inpatient care for a left foot osteomyelitis. The patient showed a labile mood and hostile behavior towards medical staff throughout hospitalization. Intermittently refused medical treatment and routine evaluations. She complained of abdominal discomfort but refused to speak and provide further details upon interrogation. History taking and physical examination were limited due to her uncooperative behavior. Laboratory workup showed no electrolyte or metabolic disturbances. Abdominal X-ray was remarkable for changes consistent with severe constipation. Due to persistent abdominal pain, an Abdominopelvic CT scan was performed for further assessment. It showed a distended rectum with fecal impaction and associated stercoral colitis. The patient was educated about complications concerning diagnosis, and treatment options were discussed with the patient. Treatment included daily mineral oil enemas and digital fecal disimpaction. She was reluctant to cooperate with proposed therapy at first. We consulted with psychiatry service to optimize psychiatric medications. With time, the patient became more cooperative and receptive to medical therapy. Fecal impaction resolved, and symptoms improved. The patient was safely discharged to a rehabilitation facility. Stercoral colitis is under-documented in the medical literature; therefore, awareness of the condition and recognizing signs and symptoms of this potentially fatal condition is imperative. Comorbidities may delay the diagnosis by preventing optimal history taking and masking physical examination. This case also highlights the importance of an interdisciplinary team when caring for a complex patient.