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 |