A 73-year-old female with hypothyroidism, presented with abdominal pain due to chronic constipation. She had been on long term opioid analgesics for arthritis.

Computer Tomography of abdomen and pelvis revealed distended large bowel with faecal impaction with inflammatory changes in splenic flexure suggestive of stercoral colitis. (Figure 1)

 

Fig 1 Coronal contrast enhanced computed tomography images of the abdomen show (A) faecal distention of a segment of colon at splenic flexure with associated fat stranding. Compare with normal bowel (B).

 

Colonoscopy showed two small benign polys in transverse colon. She was treated with laxatives and antibiotics before discharged after surgical review.

Stercoral Colitis (SC) is an inflammatory colitis, a rare complication of constipation and faecal impaction.1 SC is a cause of around 3.2% of colonic perforations.2 Computed tomography scan is the most sensitive and specific investigation for the diagnosis of SC.3 Mortality rate can be as high as 35% in SC associated perforations.4 Therefore, early diagnosis and removal of faecal impaction is essential in reducing mortality.


Authors

S Vijayabandara, Department of Health and Ageing, Conquest Hospital, East Sussex Healthcare NHS Trust

MJH Rahmani, Department of Health and Ageing, Conquest Hospital, East Sussex Healthcare Trust

A Kiani, Department of Radiology, Conquest Hospital, East Sussex Healthcare Trust


References

  1. Heffernan C, Pachter HL, Megibow AJ, Macari M. Stercoral colitis leading to fatal peritonitis: CT findings. AJR Am J Roentgenol. 2005 Apr;184(4):1189-93. [PubMed]
  2. Maurer CA, Renzulli P, Mazzucchelli L, Egger B, Seiler CA, Büchler MW. Use of accurate diagnostic criteria may increase incidence of stercoral perforation of the colon. Dis Colon rectum. 2000; 43:991–8.
  3. Ünal E, Onur MR, Balcı S, Görmez A, Akpınar E, Böge M. Stercoral colitis: diagnostic value of CT findings. Diagn Interv Radiol. 2017 Jan-Feb;23(1):5-9. [PMC free article] [PubMed]
  4. SP R, Horton KM, Fishman EK. MDCT and CT angiography evaluation of rectal bleeding: the role of volume visualization. AJR Am J Roentgenol. 2013;201(3):589-97. https://doi.org/10.2214/AJR.12.10357.