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Stercoral colitis complicated with ischemic colitis: a double-edge sword

BACKGROUND: Stercoral colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with ischemic colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on a...

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Autores principales: Naseer, Maliha, Gandhi, Jenil, Chams, Noor, Kulairi, Zain
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704496/
https://www.ncbi.nlm.nih.gov/pubmed/29179680
http://dx.doi.org/10.1186/s12876-017-0686-6
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author Naseer, Maliha
Gandhi, Jenil
Chams, Noor
Kulairi, Zain
author_facet Naseer, Maliha
Gandhi, Jenil
Chams, Noor
Kulairi, Zain
author_sort Naseer, Maliha
collection PubMed
description BACKGROUND: Stercoral colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with ischemic colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on abdominal perforation resulting from stercoral colitis. However, stercoral colitis complicated by ischemic colitis is rare. The purpose of this case report is to describe the potential challenges in the diagnosis and management of stercoral colitis with ischemic colitis. CASE PRESENTATION: An 87 years old male with history of chronic constipation presents with severe abdominal pain to the emergency department. The patient was hemodynamically stable. On physical examination, the abdomen was mildly distended with moderate tenderness. Lab work was significant for leukocytosis and lactic acidosis. Abdominal CT scan revealed large amount of retained stool in the colon, bowel wall thickening and infiltration of peri-colonic fat, which were suggestive for stercoral colitis. Patient was started on IV fluids and antibiotics. He was given an enema, followed by laxative and manual disimpaction of stool. Colonoscopy was performed and biopsies were obtained. Tissue biopsy was significant for focal active colitis with regenerative glandular changes and neural hyperplasia. CONCLUSION: Elevated lactic acid level secondary to ischemia of the bowel wall with CT scan findings aid in establishing the diagnosis of stercoral colitis complicated with ischemic colitis. Urgent treatment with laxatives and fecal disimpaction is indicated to prevent perforation and peritonitis.
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spelling pubmed-57044962017-12-05 Stercoral colitis complicated with ischemic colitis: a double-edge sword Naseer, Maliha Gandhi, Jenil Chams, Noor Kulairi, Zain BMC Gastroenterol Case Report BACKGROUND: Stercoral colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with ischemic colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on abdominal perforation resulting from stercoral colitis. However, stercoral colitis complicated by ischemic colitis is rare. The purpose of this case report is to describe the potential challenges in the diagnosis and management of stercoral colitis with ischemic colitis. CASE PRESENTATION: An 87 years old male with history of chronic constipation presents with severe abdominal pain to the emergency department. The patient was hemodynamically stable. On physical examination, the abdomen was mildly distended with moderate tenderness. Lab work was significant for leukocytosis and lactic acidosis. Abdominal CT scan revealed large amount of retained stool in the colon, bowel wall thickening and infiltration of peri-colonic fat, which were suggestive for stercoral colitis. Patient was started on IV fluids and antibiotics. He was given an enema, followed by laxative and manual disimpaction of stool. Colonoscopy was performed and biopsies were obtained. Tissue biopsy was significant for focal active colitis with regenerative glandular changes and neural hyperplasia. CONCLUSION: Elevated lactic acid level secondary to ischemia of the bowel wall with CT scan findings aid in establishing the diagnosis of stercoral colitis complicated with ischemic colitis. Urgent treatment with laxatives and fecal disimpaction is indicated to prevent perforation and peritonitis. BioMed Central 2017-11-28 /pmc/articles/PMC5704496/ /pubmed/29179680 http://dx.doi.org/10.1186/s12876-017-0686-6 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Naseer, Maliha
Gandhi, Jenil
Chams, Noor
Kulairi, Zain
Stercoral colitis complicated with ischemic colitis: a double-edge sword
title Stercoral colitis complicated with ischemic colitis: a double-edge sword
title_full Stercoral colitis complicated with ischemic colitis: a double-edge sword
title_fullStr Stercoral colitis complicated with ischemic colitis: a double-edge sword
title_full_unstemmed Stercoral colitis complicated with ischemic colitis: a double-edge sword
title_short Stercoral colitis complicated with ischemic colitis: a double-edge sword
title_sort stercoral colitis complicated with ischemic colitis: a double-edge sword
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704496/
https://www.ncbi.nlm.nih.gov/pubmed/29179680
http://dx.doi.org/10.1186/s12876-017-0686-6
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