Non-perforated Stercoral Colitis patients with septic shock have a higher mortality than their perforated counterparts. A case report and review of literature

An Atypical Cause of Pneumatosis Intestinalis: Norovirus Infection in an Elderly Male

Norovirus is a major cause of gastroenteritis, commonly presenting with nausea, vomiting, diarrhea, myalgia, and fever. Most cases are self-limited, but serious complications can occur, particularly in high-risk populations. Pneumatosis intestinalis is an uncommon but serious condition that may require surgical intervention and is characterized by the presence of gas in the bowel wall. Pneumatosis intestinalis is a known, albeit extremely rare, complication of norovirus infection. We report a case of norovirus gastroenteritis in a 77-year-old male complicated by septic shock, pneumatosis intestinalis, and gastrointestinal bleeding, highlighting a rare but serious manifestation of this common infection.

Forensic considerations in cases of fatal constipation

Constipation is characterized by persistent difficulty in defecating. It is a common disorder in the community particularly affecting the elderly and those with intellectual disabilities and neuropsychiatric disorders. It is also caused by numerous medications including analgesic, antidepressant, antihypertensive and anticholinergic agents. It may be asymptomatic or it may produce abdominal pain/cramps, bloating, nausea and anorexia progressing to urinary incontinence and fecal impaction, or paradoxical diarrhea due to overflow. A wide range of mechanisms associated with constipation may result in death including bowel obstruction, stercoral colitis with ulceration, perforation and peritonitis, respiratory compromise, abdominal compartment syndrome and venous thrombosis with pulmonary thromboembolism. Constipation may exacerbate pre-existing diseases and treatments such as laxative and enemas may be lethal. The autopsy examination of a case with constipation and megacolon should take into account all of the pre-existing conditions, as well as the possibility of underlying disorders such as Hirschprung disease. Review of the decedent's medical and drug history and level of supportive care will be important. Toxicological evaluations may be useful.

18 F-FDG PET/CT Findings of a Patient With Stercoral Colitis

ABSTRACT

Stercoral colitis is a colonic inflammation caused by fecal impaction. It is now more commonly discussed in the literature due to its clinical significance, which has gained recognition in recent years. Delayed diagnosis may result in complications such as sepsis and perforation, which have a high mortality rate. Reporting incidentally detected stercoral colitis on FDG PET/CT can help prevent mortality and morbidity by enabling early diagnosis and treatment. In this case, we report on a patient with gastric cancer who was identified with stercoral colitis using FDG PET/CT data.

Stercoral colitis in the emergency department: a review of the literature

BACKGROUND

Stercoral colitis (SC) is a rare but potentially life-threatening inflammatory colitis caused by the accumulation of impacted fecal material. Despite reported associations with bowel perforation and high mortality rates, stercoral colitis remains a poorly defined and underrecognized diagnosis in the emergency department (ED).

OBJECTIVE OF THE REVIEW

This review aims to summarize and synthesize existing literature on SC to guide its recognition and management in the ED.

DISCUSSION

SC primarily occurs in elderly or bedbound patients with chronic constipation; however, it does occur in younger patients with comorbidities at increased risk for fecal impaction. Patients may present acutely with abdominal pain and distension, but clinical presentation is often nonspecific and varied, and there are no established diagnostic criteria for SC to date. CT is therefore crucial for diagnosis, revealing key findings such as fecaloma, colonic dilatation, and fat stranding. Treatment depends on severity of illness, ranging from manual disimpaction and other conservative measures for most cases, to surgical intervention for complicated cases, such as stercoral perforation.

CONCLUSIONS

SC can be a challenging diagnosis in the ED, often requiring multidisciplinary collaboration. Timely recognition and appropriate treatment are essential to reduce morbidity and mortality associated with this condition. Further research is needed to establish diagnostic criteria and clear management algorithms.

Diagnosis and emergency surgical management of stercoral colitis-induced colonic ischemia: A case report and literature review

INTRODUCTION AND IMPORTANCE

Stercoral colitis is an urgent complication of fecal impaction that requires aggressive management. The rare complicated with bowel ischemia requires a high index of suspicion for early diagnosis. This case report describes the detection and management of this rare and fatal complication of stercoral colitis.

CASE PRESENTATION

An 80-year-old man presented after 3 days of obstipation. Abdominal plain radiography revealed several air-fluid levels in the colon with centralized small bowel gas. Computed tomography revealed fecal impaction and stercoral colitis without evidence of bowel ischemia.

CLINICAL DISCUSSION

Fecal impaction and stercoral colitis without evidence of bowel ischemia was suspected. Owing to the development of refractory septic shock, we performed damage control surgery. Definitive surgery with end ileostomy was follow by 48 h later. The patient was discharged home safely.

CONCLUSION

Stercoral colitis-induced ischemia is rare but potentially fatal; ischemia should be highly suspected. CT can help diagnosed of stercoral colitis but no single parameters for diagnosed of bowel ischemia. Prompt resuscitation and surgical exploration with damage control surgery are recommended.