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Table 1 Comparison of our patient with published data on stercoral colitis

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

Case #

Patient

Past Medical History

Presentation

Physical Examination Findings

Laboratory Findings

Imaging Findings

Course of Stay

1 (our case)

87-year-old male

HTN, Hypercholesterolemia, benign colon polyps, & chronic constipation

Severe diffuse abdominal pain with distension and bloating sensation of 5 days duration

Abdominal exam: moderate diffuse tenderness but no rigidity or guarding;

Rectal exam: impacted stool

Leukocytosis and lactic acidosis

AXR: large amount of gas and fecal retention throughout the colon and rectum with no evidence of free intraperitoneal air; Contrast-enhanced CT abdomen/pelvis: large number of retained stools in the colon, bowel wall thickening and infiltration of peri-colonic fat

Findings suggestive of stercoral colitis complicated with ischemic colitis treated with I.V. fluids and antibiotics; Enema, followed by laxative and manual disimpaction of stools; symptoms were resolved and lactate levels returned to normal; patient became stable and discharged home

2 (12)

35-year-old male

Schizoaffective disorder

Diffuse cramping abdominal pain and constipation of 4 days duration

Abdominal exam: marked distention, diffuse tenderness to palpation, and stool palpable in the left lower quadrant with normal bowel sounds;

Rectal exam: refused

Normal

Contrast-enhanced CT abdomen/pelvis: stool impaction with colonic wall thickening, but no small bowel obstruction, obstructing mass, or volvulus

Despite I.V. fluids and laxatives course was complicated with lactic acidosis and perforation of transverse colon with mucosal ulceration and focal ischemia. Patient underwent sub-total colectomy and was discharged with an ileostomy

3 (12)

26-year-old male

Long history of anxiety around using the restroom, after experiencing an earthquake while using the toilet at age 6

Constipation of 1 week; cramping abdominal pain in the lower quadrants and shortness of breath

Abdominal exam: distended and nontender, with stool palpable in the left lower quadrant and normal bowel sounds throughout;

Rectal exam: hard stool palpated in the rectal vault

Normal

AXR: dilated colon with severe fecal impaction, without pneumoperitoneum; Contrast-enhanced CT abdomen/pelvis: fecal impaction with signs of bowel ischemia, but no free air or ascites were identified

Patient was treated with I.V. fluids, oral laxatives, and water enemas. Discharged home in stable condition

4 (13) limited data

76-year-old male

DM, HTN, arrhythmia, chronic constipation

Acute abdomen; febrile

N/A

Leukocytosis

CT abdomen/pelvis: fecal impaction at recto-sigmoid colon; colon mucosal perfusion defect; pericolonic stranding;

Operation findings/Pathology: Ischemic change from sigmoid to rectum with necrotic mucosa/Ischemia necrosis with

mucosal sloughing

Alive; limited information

5 (13) limited data

39-year-old male

ESRD, chronic constipation

Acute abdomen; hypotensive and febrile

N/A

Borderline leukocytosis

CT abdomen/pelvis: fecal impaction at recto-sigmoid colon with proximal dilatation; pericolonic stranding;

Operation findings/Pathology: Ischemic patches over sigmoid colon with impending perforation/Ischemic and gangrenous

change of the sigmoid colon

Dead, 3 days after CT; limited information

6 (13) Limited data

83-year-old male

ARDS, HF, HTN, COPD, chronic constipation

Acute abdomen

N/A

Leukocytosis

CT abdomen/pelvis: fecal impaction at recto-sigmoid colon; colon wall thickening; colon mucosal perfusion defect; pericolonic stranding;

Operation findings/Pathology: Ischemic change of small bowel and sigmoid colon/Transmural necrosis of sigmoid colon and mucosal necrosis of small bowel

Dead, 11 days after CT; limited information

  1. HTN Hypertension, AXR Abdominal X-ray, DM Diabetes mellitus, N/A Not available, ESRD End-stage renal disease, ARDS Acute respiratory distress syndrome, HF Heart failure, COPD Chronic obstructive pulmonary disease