Stercoral Ulcer Not Always Indolent: A Rare Complication of Fecal Impaction.

Chellappa Vijayakumar,Erabati Santosh Raja,Singh Amankumar,Ravi Prabhu,K Balagurunathan,Raja Kalaiarasi,Swetha T

doi:10.7759/cureus.2613

Abstract

Stercoral sigmoid perforation is a dangerous surgical emergency. It is also a life-threatening situation because the spillage of fecal contents into the abdominal cavity leads to sepsis with many postoperative complications. Chronic, intermittent constipation can lead to fecal impaction, especially in older patients.An 80-year-old male patient presented with intestinal abdominal pain and distention for three days. His chest X-ray showed air under the diaphragm. On laparotomy, a small rent was discovered in the rectosigmoid junction with fecal contamination. The presence of a fecaloma is the speculated reason for the perforation. Primary closure of the defect with a diverting transverse colostomy was performed, and subsequently, the patient recovered well. A colostomy closure was performed six weeks after the primary surgery.It is imperative to understand the incidence of stercoral perforation in a normal bowel. Early treatment and intervention are the important aspects of stercoral pathology. We report a rare case of stercoral sigmoid colonic perforation with fecal peritonitis.

Highlights

Fecal impaction is one of the common causes of subacute intestinal obstruction in elderly patients [1]
Intermittent constipation can lead to fecal impaction, especially in older patients
We report a rare case of stercoral sigmoid colonic perforation with fecal peritonitis

Summary

Introduction

Fecal impaction is one of the common causes of subacute intestinal obstruction in elderly patients [1]. The most common site of obstruction is the rectosigmoid junction These impacted stools cannot be evacuated spontaneously or manually. 7% of patients are found to have impacted stools [2] They are prone to hollow viscus perforation. Large intestinal perforations are very rare, but it usually occurs in patients with inflammatory bowel diseases, diverticular anomalies, and malignancies. The most common site for stercoral perforation is the sigmoid region, especially in the rectosigmoid junction. Ultrasound showed distended bowel loops with significant free fluid in the peritoneal cavity. The patient was followed up regularly, and the colostomy closure was done six weeks after the primary surgery

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Berry J