STERCORAL PERFORATION OF THE SIGMOID COLON

Abstract

Stercoral perforation of the sigmoid colon is a rare event resulting in severe peritonitis and is associated with a high mortality rate. Since 1894 fewer than 90 cases have been reported in the medical literature, and a MEDLINE search revealed only 48 articles on this topic over the last 3 5-year time period. We present five cases of stercoral perforation of the sigmoid colon observed in a 350-bed community hospital over an eight-year period. All our patients underwent urgent surgical procedures including peritoneal lavage, resection of as much colon as possible, along with Hartmann closure and colostomy. Histology showed the perforations to be distinctly different from a diverticular perforation. Three of our patients died shortly after their initial presentation while our fourth patient had delayed mortality undoubtedly related to this illness. Our experience with this disease leads us to the following conclusions: (1) Patients with severe obstipation and absent bowel movements for over one week are at particular risk. (2) The severity of the abdominal pain in the absence of initial overt radiological signs of perforation may be an important clue to the diagnosis (3) The initial physical examination may not show peritoneal signs (4) Rectal examination frequently shows no stool because the impaction is above the rectosigmoid junction and (5) Absent stool in the rectal ampullae may cause physicians to underestimate the significance of the patient's problem and contribute to a false sense of security in the face of an impending perforation. We believe stercoral perforation of the sigmoid colon is an underreported entity and we urge our colleagues to report more cases of this illness.Table: Patient Characteristics