Stercoral Perforation Research Articles

WP7.1 - MRI for suspected acute appendicitis in pregnant females: What is the best imaging modality?

Abstract Introduction/Aims Acute appendicitis (AA) in pregnancy is the commonest non-obstetric cause of acute abdominal pain, but controversy surrounds the most appropriate imaging modality in this group. Ultrasound (USS) and Magnetic Resonance Imaging (MRI) have no known fetal risks. Hence, The World Society of Emergency Surgeons (WSES) recommends MRI in pregnant patients with suspected appendicitis, if available, but emphasises the preferred initial use of USS. This project explored the use of both imaging modalities in pregnant patients with suspected AA. Method Data was collected for all pregnant patients undergoing an MRI for suspected AA between 2015 and 2023. Results Of the 29 patients identified, the mean gestation was 23 weeks (range 2-36), and over half (15, 52%) of MRI scans were performed in 2022/3. Intra-abdominal pathology was seen in 17 (59%) patients, with 8 (47%) having MRI features of AA. 63% of those diagnosed with AA had an USS pre-MRI, and 40% identified the appendix as "normal." Other intra-abdominal pathologies picked up on MRI included pyelonephritis(1), small bowel obstruction(1), stercoral perforation(1), and ovarian torsion(2). Of the 8 patients with MRI-proven AA, all underwent appendicectomy: 3 laparoscopic, 2 open, and 3 with simultaneous Caesarean section, of whom 2 required ileocaecal resection. Conclusions Diagnosis of abdominal pain in pregnancy is a challenge. USS may be reasonably sensitive and specific in dedicated hands, but pathology may still be missed. In this patient group, for which appendicectomy for AA is associated with better outcomes than non-operative management, MRI should be obtained for accurate diagnosis.

Dealing with the Unexpected: Stercoral Perforation – A Surgical Conundrum

Stercoral colon perforation is a rare surgical emergency primarily linked to chronic constipation and advanced age. Diagnosis is challenging and requires established criteria and imaging. Urgent surgery is the modality of choice, typically involving Hartmann's procedure. Mortality rates can be as high as 60%, emphasising the need for early diagnosis and intervention. We presented a case of a 71-year-old bedridden female with a history of stroke, diabetes, and hypertension presenting with abdominal pain, fever and diarrhoea. Initial evaluation indicated dehydration, sepsis, and abdominal tenderness. An urgent imaging revealed a suspected rectal perforation, prompting emergency surgery. Intraoperatively, stercoral perforation due to impacted hard faeces was identified. Despite prompt and intensive treatment, the patient's condition deteriorated, ultimately resulting in her demise. Stercoral colon perforation is a critical condition requiring rapid diagnosis. Symptoms include abdominal distension, tenderness, cramps, fever, and anorectal pain. Healthcare providers should consider the possibility of stercoral perforation in individuals exhibiting these symptoms alongside a background of persistent constipation. Treatment involves peritoneal lavage and surgery. Early recognition is vital for proper management and improved outcomes.

AB145. SOH23ABS_157. Recurring stercoral perforation in a patient with ehlers-danlos syndrome, type 4

AB145. SOH23ABS_157. Recurring stercoral perforation in a patient with ehlers-danlos syndrome, type 4

PSAT362 Hypothyroidism Associated Colonic Rupture

Abstract A 59 year old female with history of thyroid cancer status post thyroidectomy presented with sudden onset severe and diffuse abdominal pain. CT Abdomen Pelvis with contrast showed extensive pneumoperitoneum suggestive of perforated viscus. The patient was taken to emergent diagnostic laparoscopy showing sigmoid perforation with fecal contamination and multiple large stool balls. Sigmoidectomy and end colostomy was performed for perforated sigmoid diverticulitis with feculent peritonitis. On admission, tests evaluating for thyroid function were consistent with hypothyroidism (TSH 39.700, n 0.400 - 4.500 uIU/mL). Over the previous two years, thyroid function studies were variable with both elevated and low TSH values (range 0.221-117 uIU/ml), although TSH values over the prior 12 months were not elevated. The patient reported adherence to taking levothyroxine 137 mcg daily in the outpatient setting. Furthermore, she endorsed appropriate administration of levothyroxine prior to food and was not taking the medication with any offending vitamins or minerals. Review of systems was negative for alternative causes of colonic rupture including trauma or chronic constipation. A thorough literature review was performed and revealed only 10 cases between 2004-2007 of spontaneous perforation of the colon in the absence of tumors, diverticulosis, or external injury.1 Only two reports were found linking spontaneous perforation of the colon with hypothyroidism, and proposed the causative mechanism as intestinal motility dysfunction causing chronic constipation, megacolon, or even pseudo-obstruction eventually leading to stercoral perforation.[2-3] Hypothyroid status was addressed by increasing levothyroxine dosage to 150 mcg daily. The patient recovered from septic shock and performed a 2 week course of inpatient rehabilitation from which she was discharged home with good functional status. Follow up labs evaluating thyroid status will be performed 4-6 weeks after initial testing and are still pending. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Stercoral perforation of a cecal diverticulum: A rare presentation

Introduction: Right-sided diverticular disease, including cecal diverticulum, is a relatively uncommon occurrence when compared to left-sided diverticular disease, particularly in Western countries. Even more rare than this is the perforation of these diverticulum due to stercoral colitis. Case Report: We report the case of an 83-year-old man who presented to the Emergency Department with a relatively brief history of periumbilical and right lower quadrant pain, associated with nausea and low-grade fevers, and a computed tomography (CT) scan demonstrating perforation of a large cecal diverticulum requiring acute surgical management. Conclusion: Perforation of a cecal diverticulum is rare, particularly when due to stercoral colitis, and can be often misdiagnosed. It should be considered in the context of the systemically unwell older patient with a history of constipation.

Stercoral ulcer perforation mortality: A rare presentation

Stercoral ulcers resulting from damage to the intestinal lining due to chronic constipation are rarely presented as perforations. The incidence of these perforations is 3.2% of all colonic perforations. Poor diet, anatomic factors, and certain medications increase the risk of perforations. The presentation of stercoral ulcers varies widely among patients. Immediate surgical intervention is required for these patients because of the increased risk of mortality due to severe intraperitoneal contamination. To the best of our knowledge, we report the first case from our region of patient mortality due to stercoral ulcer perforation.

Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study.

BackgroundDespite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality. MethodsA retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes.ResultsThe most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery.ConclusionAge and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

Primitive Splenic Lymphoma: A Case Report and Review of the Literature

Introduction: Malignant lymphomas are defined as malignant proliferations developed from constituents of lymphoid organs, but also from lymphoid formations contained in most organs (liver, kidneys, digestive) without blood contamination. Lymphoma is a set of monoclonal tumor proliferations developed at the expense of lymphocytes. Lymphoma is the most common malignant tumor of the spleen, but primary lymphoma of the spleen remain an exceptional presentation. We report the case of a stercoral perforation of the colon that occurred in a 67-year-old patient whose diagnosis was made on ct and we try to recall the clinical and CT characteristics of primary aneurismal spleen lymphoma. Case Report: We expose the case of a 66-year-old patient, with a history of chronic smoking, consulted in the emergency department for a sub occlusive syndrome evolving for less than 24hours. An abdominal CT was conducted: The diagnosis of stercoral colonic perforation was retained. Due to a development of hypovolemic shock, the decision was to do a laparotomy with peritoneal lavage with colonic resection followed by an ostomy of the proximal segment and drainage of the abdominal cavity. The evolution was characterized by the discharge of the patient 7 days after. Conclusion: Stercoral perforation of the colon is a rare complication of abdominal trauma. The diagnosis, often difficult and delayed, must be known by all physicians caring working in trauma centers. Stercoral perforation of the colon is a surgical emergency, the prognosis of which, often poor, depends on the terrain and the speed of treatment.

Rare but relevant: a systematic review of stercoral perforation.

Knowledge of the aetiologies of large bowel perforation are fundamental to its management. Stercoral perforation is a rare cause associated with high mortality. Owing to the paucity of coverage of this condition in the literature, this review raises awareness of stercoral perforation among clinicians. A literature search of PubMed, Embase, MEDLINE, CINAHL, Ovid and Cochrane was performed. Key search terms included 'stercoral, perforation', 'perforated', 'perforat*' and 'stercoral perforation'. Only literature published between December 2011 and July 2020 was included to avoid duplication. Twenty-nine papers were obtained giving an overall cohort of 58 patients. The median age was 58 years (range 2-83 years) and 72.4% (n=42) were female. Constipation was reported in 69% (n=40) and 20.7% (n=12) reported chronic opioid use. A computed tomography scan was performed in 94.8% (n=55) of cases and typically a Hartmann's procedure (n=40, 72.2%) was performed. The mortality rate was 17.2% (n=10). The median age of patients with stercoral perforation has decreased from that found in previous studies and the mortality rate has improved. Chronic opioid users have also emerged as an important cohort. Early recognition, diligent decision making and focused perioperative care form the backbone of the definitive management of stercoral perforation.

Stercoral perforation due to chronic constipation

Stercoral perforation due to chronic constipation

Stercoral perforation requiring a total colectomy: a challenging and extreme case

ANZ Journal of SurgeryVolume 91, Issue 9 p. 1930-1932 IMAGES FOR SURGEONS Stercoral perforation requiring a total colectomy: a challenging and extreme case Jai Hoff MD, Jai Hoff MD orcid.org/0000-0001-6436-5189 General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorGeorge Castrisos MBBS, George Castrisos MBBS orcid.org/0000-0001-9075-214X General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorGoutham Sivasuthan MBBS, Goutham Sivasuthan MBBS orcid.org/0000-0001-5774-421X General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorYiu Ming Ho MS, FRACS, Yiu Ming Ho MS, FRACS orcid.org/0000-0002-4774-3317 General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorKatarzyna Zalewska MBBS, FRACS, Katarzyna Zalewska MBBS, FRACS General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: Conceptualization, SupervisionSearch for more papers by this authorChitrakanti Kapadia MBBS, FRACS, Chitrakanti Kapadia MBBS, FRACS General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: SupervisionSearch for more papers by this author Jai Hoff MD, Jai Hoff MD orcid.org/0000-0001-6436-5189 General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: Conceptualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorGeorge Castrisos MBBS, George Castrisos MBBS orcid.org/0000-0001-9075-214X General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorGoutham Sivasuthan MBBS, Goutham Sivasuthan MBBS orcid.org/0000-0001-5774-421X General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorYiu Ming Ho MS, FRACS, Yiu Ming Ho MS, FRACS orcid.org/0000-0002-4774-3317 General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia Contribution: Writing - review & editingSearch for more papers by this authorKatarzyna Zalewska MBBS, FRACS, Katarzyna Zalewska MBBS, FRACS General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: Conceptualization, SupervisionSearch for more papers by this authorChitrakanti Kapadia MBBS, FRACS, Chitrakanti Kapadia MBBS, FRACS General Surgery Department, Rockhampton Hospital, Rockhampton, Queensland, Australia Contribution: SupervisionSearch for more papers by this author First published: 06 January 2021 https://doi.org/10.1111/ans.16556Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume91, Issue9September 2021Pages 1930-1932 RelatedInformation

A rare occurrence of road accident: Stercoral colonic perforation

A rare occurrence of road accident: Stercoral colonic perforation

Clinical features of stercoral perforation of colon compared with perforated colon diverticulum: A single center experience

Clinical features of stercoral perforation of colon compared with perforated colon diverticulum: A single center experience

Prognostic Factors of Patients with Stercoral Perforation of the Colon.

The incidence of stercoral perforation of the colon (SPC) is expected to rise, given the increased life expectancy and the aging population. On the other hand, the prognostic factors of mortality after surgery for SPC remain unclear. This study examined the prognostic factors of patients with SPC after surgery. The medical records of 145 patients who underwent surgery for colonic perforation between April 2010 and May 2019 were reviewed retrospectively. In 145 patients, 22 patients who underwent SPC surgery were categorized into the following two groups according to in-hospital survival after surgery: alive (group A, n=15) and dead (group B, n=7). In all enrolled patients, the mean age was 75.7±9.0 years, with a female predominance (female patients, n=19, 86.4%). Sixteen patients (72.7%) had chronic constipation with medications, and five patients (22.7%) were bedridden. The rate of preoperative bedridden status was significantly higher in group B than group A (6.7% vs. 57.1%; p=0.021). Univariate analysis revealed immobility, a sequential organ failure assessment (SOFA) score, and lactate levels of more than 2.0 mmol/L to be factors associated with increased mortality rates in the postoperative period. Multivariate analysis revealed abnormal lactate levels to be the only factor related to mortality (hazard ratio 16.50, 95% CI 1.48-183.07, p=0.022). Preoperative abnormal serum lactate levels may be a risk factor for mortality after surgery in patients with stercoral perforation. Further research will be needed to identify the postoperative prognostic SPC factors.

S1761 Too Much of a Good Thing: Stercoral Perforation Following Resumption of a High Fiber Diet After Colonoscopy

S1761 Too Much of a Good Thing: Stercoral Perforation Following Resumption of a High Fiber Diet After Colonoscopy

S3391 Life-Threatening Complication of Chronic Constipation in a Young Patient

INTRODUCTION: Bowel Perforation secondary to stool impaction is a rare entity which has amortality rate of 32-57%. It has Predilection to age 22-85. Risk factors include chronic constipation, NSAIDs, narcotics, antacids, steroids, antidepressants and antipsychotics. Stercoral perforation results from compression of colonic mucosaby a hard fecaloma causing mucosal ischaemia on antimesenteric border withulceration and perforation. CASE DESCRIPTION/METHODS: A 41Year Old Female with PMH of Bipolar disorder, Hypothyroid, HTN, substanceabuse, End Stage Kidney Disease presented with diffuse severe abdominal pain for 2 days. She had bowel enema done one day prior to her presentation. Pain was 10/10 intensity associated with nausea and dizziness. Vitals Pulse rate 115/min, Respiratory rate 22/min, Blood pressure 90/54mmHg, Temperature 98.5F. Her Home medications included Methadone, Quetiapine, Trazodone, Clonazepam, Docusate, Levothyroxine.On examination, abdomen was diffusely tender with signs of peritonitis. Labs WBC: 3.80, AST/ALT 1277/989, Alkaline phosphatase 380, Total bilirubin 2.0. Hepatitis panel negative. Abdominal CT showed chronic obstruction with bowelperforation of redundant sigmoid colon and massively dilated colon with full of stool. Pt was immediately taken to surgery after initial resuscitation and antibiotics. Pt had left Hemicolectomy with primary anastomosis and drain placedin the paracolic gutter. Intraoperatively she was found to have ruptured proximaldescending colon secondary to rock hard stools with generalized fecal peritonitis and pathology report showed colonic transmural Necrosis. She was transferred toICU due to septic shock from Enterococcus faecalis bacteremia started on Zyvox.Patient went into cardiac arrest. Despite aggressive management, unfortunately Pt did not survive. DISCUSSION: Due to widespread use of opioids, antidepressants and antipsychotics earlyrecognition and proper management of constipation is crucial to prevent mortality. Only 10% of individuals are correctly diagnosed and managed properly. Our Pt was taking antipsychotics, antidepressants in addition to Methadone. This resulted in constipation due to disturbances with the migrating myoelectriccomplex causing delay in fecal transit time. Avoiding enema in a Pt like this would be a crucial step as the mucosa is very fragile to cause perforation easily. Frequent monitoring and proper management of constipation could save many young lives.Figure 1Figure 2

Spontaneous colonic perforation in adults: Evaluation of a pooled case series.

Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann's operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features (p ≤ 0.001, p = 0.005). Age of patients was associated with both postoperative complication (p = 0.012, p = 0.044) and mortality (p = 0.013, p = 0.034). Univariate analysis showed that HSP was associated with postoperative complication (p = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.

Unexpected cause of acute abdomen in a young healthy woman: the stercoral perforation.

Unexpected cause of acute abdomen in a young healthy woman: the stercoral perforation.

A Case of Stercoral Perforation of the Sigmoid Colon in a Hemodialysis Patient

A Case of Stercoral Perforation of the Sigmoid Colon in a Hemodialysis Patient

Stercoral perforation: A rare case and review

We present a 54 year old male with abdominal pain, Vomiting and weight loss since 5 months. Perforation was noted at recto-sigmoid junction and underwent Hartman’s procedure with end colostomy. Histology of sigmoid colon confirmed a Stercoral perforation without any evidence of dysplasia or malignancy .Stercoral perforation always need to kept in mind in patients who present with constipation and need to take all patients who present with chronic constipation and initiate measures we encounter commonly in everyday practice. We present a brief review about Stercoral perforation and its management.