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Vandaele T, Dekoninck L, Vanhove P, Devos B, Vandeputte M, Philippe M, Vlasselaers J. Rectal stercoral perforation: an uncommon anatomical localization of a rare surgical emergency. J Surg Case Rep 2024; 2024:rjad704. [PMID: 38186757 PMCID: PMC10764203 DOI: 10.1093/jscr/rjad704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024] Open
Abstract
A stercoral rectal perforation is an uncommon cause of acute abdominal pain with only limited cases documented in medical literature. Timely and accurate imaging is essential when this condition is suspected, and immediate surgical intervention is imperative upon confirming the diagnosis of bowel perforation. Usually, the definitive diagnosis of a stercoral rectal perforation is established intraoperatively and a Hartmann procedure with (temporary) end colostomy is performed. In this case report, we present our first-hand experience in managing a stercoral rectal perforation, highlighting the importance of early diagnosis and rapid surgical intervention to achieve favorable outcomes.
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Affiliation(s)
- Tom Vandaele
- Department of General Surgery, General Hospital Zeno, Knokke-Heist 8300, Belgium
| | - Lisa Dekoninck
- Department of General Surgery, General Hospital Zeno, Knokke-Heist 8300, Belgium
| | - Pauline Vanhove
- Department of General Surgery, General Hospital Zeno, Knokke-Heist 8300, Belgium
| | - Bart Devos
- Department of General Surgery, General Hospital Zeno, Knokke-Heist 8300, Belgium
| | - Mathieu Vandeputte
- Department of General Surgery, General Hospital Zeno, Knokke-Heist 8300, Belgium
| | - Marc Philippe
- Department of General Surgery, General Hospital Zeno, Knokke-Heist 8300, Belgium
| | - Johan Vlasselaers
- Department of General Surgery, General Hospital Zeno, Knokke-Heist 8300, Belgium
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Lee F, Cao J, Lin E, Kurashima M, Okeke RI, Saliba C, Miyata S. The Extremes of Constipation: A Case of Stercoral Perforation From Fecal Impaction in a Teenager. Cureus 2023; 15:e43554. [PMID: 37719582 PMCID: PMC10502519 DOI: 10.7759/cureus.43554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Stercoral perforation is a rare sequela of poorly controlled constipation that is more commonly seen in older, bedridden patients than in pediatric patients. We present the case of a 13-year-old patient requiring a divided sigmoid colostomy following rectal perforation, one of the few examples in the pediatric literature of stercoral perforation from chronic constipation. The current report highlights the importance of appropriate treatment of functional constipation at onset and the life-threatening complications that can occur without appropriate follow-up.
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Affiliation(s)
- Felicia Lee
- Medical School, Saint Louis University School of Medicine, Saint Louis, USA
| | - Jasmin Cao
- Medical School, Saint Louis University School of Medicine, Saint Louis, USA
| | - Evan Lin
- Medical School, Saint Louis University School of Medicine, Saint Louis, USA
| | - Maho Kurashima
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
| | - Raymond I Okeke
- General Surgery, SSM Health Saint Louis University Hospital, Saint Louis, USA
| | - Christian Saliba
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
| | - Shin Miyata
- Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis, USA
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Fernando S, Sarma DR. Rare but relevant: a systematic review of stercoral perforation. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 33914628 DOI: 10.12968/hmed.2020.0659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIMS Knowledge of the aetiologies of large bowel perforation are fundamental to its management. Stercoral perforation is a rare cause associated with high mortality. Owing to the paucity of coverage of this condition in the literature, this review raises awareness of stercoral perforation among clinicians. METHOD A literature search of PubMed, Embase, MEDLINE, CINAHL, Ovid and Cochrane was performed. Key search terms included 'stercoral, perforation', 'perforated', 'perforat*' and 'stercoral perforation'. Only literature published between December 2011 and July 2020 was included to avoid duplication. RESULTS Twenty-nine papers were obtained giving an overall cohort of 58 patients. The median age was 58 years (range 2-83 years) and 72.4% (n=42) were female. Constipation was reported in 69% (n=40) and 20.7% (n=12) reported chronic opioid use. A computed tomography scan was performed in 94.8% (n=55) of cases and typically a Hartmann's procedure (n=40, 72.2%) was performed. The mortality rate was 17.2% (n=10). CONCLUSIONS The median age of patients with stercoral perforation has decreased from that found in previous studies and the mortality rate has improved. Chronic opioid users have also emerged as an important cohort. Early recognition, diligent decision making and focused perioperative care form the backbone of the definitive management of stercoral perforation.
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Affiliation(s)
- Sherwin Fernando
- Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Diwakar R Sarma
- Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Lee S, Kim CW. Stercoral re-perforation after colostomy takedown: a case report. BMC Surg 2021; 21:126. [PMID: 33750354 PMCID: PMC7945347 DOI: 10.1186/s12893-021-01118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Stercoral perforation (SP) is a rare surgical condition that is associated with high morbidity and mortality. Most of these patients undergo emergent surgery, including colostomy, and some undergo colostomy takedown after recovery. Stercoral re-perforation after colostomy takedown followed by colostomy for SP has not yet been reported. Case presentation A 79-year-old woman presented with abdominal pain for one day. Abdominal-pelvis computed tomography revealed pneumoperitoneum with diffuse mesenteric fat haziness of the left abdomen. During laparoscopic exploration, a 3-cm-sized perforated site was found at the sigmoid-descending colon, with fecal material and reactive fluid outside the colon. Loop colostomy formation was performed, and a takedown was completed after 3 months. Two years 4 months after the initial procedure, the patient was re-admitted to our hospital with abdominal pain. She underwent a second laparoscopic colostomy formation and was discharged, although the postoperative clinical course was poorer than that after the first surgery. Conclusions This case of stercoral re-perforation after colostomy takedown followed by colostomy formation for SP has important clinical implications and can be a reference for physicians. When the first colostomy formation was performed for SP, the decision on performance of a colostomy takedown should be made after carefully considering several factors.
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Affiliation(s)
- Seunghwan Lee
- Department of Surgery, Kyung Hee University Hospital At Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, 05278, Seoul, South Korea
| | - Chang Woo Kim
- Department of Surgery, Kyung Hee University Hospital At Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, 05278, Seoul, South Korea.
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Mounir B, Oussama L, Zineb AEA, Abdelilah EB, Khalid EH, Fatima-Zahra B, Abdelaaziz F. Stercoral perforation of the colon: a mortal consequence of chronic constipation in the elderly (a case report). Pan Afr Med J 2021; 38:48. [PMID: 33854677 PMCID: PMC8017362 DOI: 10.11604/pamj.2021.38.48.22948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022] Open
Abstract
The stercoral perforation is a mortal condition. It affects elderly patients who have a long history of chronic and severe constipation as well as constitutes a surgical emergency whose prognosis, often grim, depends on the early diagnosis and treatment. We report the case of a stercoral colon perforation which occurred in an 89-year-old patient. The clinical symptomatology was that of an acute peritonitis evolving for four days. The diagnosis was only made intraoperatively and the surgical gesture was a resection of the involved left colon segment and Bouilly Volkmann colostomy. The consequences were unfortunately marked by a resistant septic shock resulting in the death of the patient on the 1st postoperative day. The diagnosis of stercoral colon perforation, which is often difficult and delayed, must be known by all physicians who manage an increasingly older patient population.
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Affiliation(s)
- Bouali Mounir
- Department of Visceral Surgical Emergency, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Lafkih Oussama
- Department of Visceral Surgical Emergency, Ibn Rochd University Hospital, Casablanca, Morocco
| | | | - El Bakouri Abdelilah
- Department of Visceral Surgical Emergency, Ibn Rochd University Hospital, Casablanca, Morocco
| | - El Hattabi Khalid
- Department of Visceral Surgical Emergency, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Bensardi Fatima-Zahra
- Department of Visceral Surgical Emergency, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Fadil Abdelaaziz
- Department of Visceral Surgical Emergency, Ibn Rochd University Hospital, Casablanca, Morocco
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Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury. Case Rep Surg 2020; 2020:8881840. [PMID: 33062368 PMCID: PMC7547356 DOI: 10.1155/2020/8881840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/11/2020] [Accepted: 09/25/2020] [Indexed: 11/18/2022] Open
Abstract
Background Patients with cervical spinal injury with quadriplegia are at an increased risk of developing serious gastrointestinal complications. We report an unusual case of spontaneous rectosigmoid perforation in a quadriplegic patient. Case Presentation. A 58-year-old man with diabetes mellitus and hypertension presented to the emergency department following a fall from 25 feet of height. He sustained a fifth cervical vertebral fracture with quadriplegia and neurogenic shock. One week later, he developed progressive abdominal distension with tachycardia, low blood pressure, and respiratory distress. His abdomen was soft but had impaired liver dullness. Imaging showed evidence of visceral perforation. He underwent an emergency laparotomy and was found to have a perforation of the antemesenteric border of the rectosigmoid junction with fecal contamination. The perforation was repaired primarily, and a temporary loop ileostomy was created. The patient received intensive care for 4 days, and thereafter, the recovery was uneventful. He was later transferred to the spinal unit for further management. The intraoperative findings, histology, and subsequent colonoscopy did not reveal any underlying cause for the perforation. Conclusions Clinical signs and symptoms are generally absent in patients following spinal cord injury, and the diagnosis of serious gastrointestinal pathology can be difficult and challenging. We believe that ischemia at the rectosigmoid junction precipitated by multiple factors was the possible reason for the spontaneous perforation.
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Gupta AK, Vazquez OA, Lopez-Viego M. Pelvic Rectal Stercoral Perforation Resulting in Diffuse Pneumatosis. Cureus 2020; 12:e9146. [PMID: 32789083 PMCID: PMC7417182 DOI: 10.7759/cureus.9146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An 83-year-old woman with oral corticosteroid use for chronic autoimmune conditions presented with abdominal pain and constipation for the previous seven days. CT of the abdomen and pelvis revealed a large fecaloma with diffuse pneumatosis involving the retroperitoneum, subcutaneous tissue, and mediastinum. An emergent exploratory laparotomy revealed perforation of the rectum below the peritoneal reflection into the retroperitoneum. An end-colostomy with Hartmann's operation was then performed intra-operatively. Despite operative treatment complicated by prolonged intubation, the patient succumbed to multiorgan failure and expired.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Oscar A Vazquez
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Miguel Lopez-Viego
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA.,Surgery, Bethesda Hospital, Boynton Beach, USA
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Chongxi R, Jinggang J, Yan S, Hongqiao W, Yan L, Fengshuo Y. Spontaneous colonic perforation in adults: Evaluation of a pooled case series. Sci Prog 2020; 103:36850420945462. [PMID: 32993458 PMCID: PMC10451056 DOI: 10.1177/0036850420945462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann's operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features (p ≤ 0.001, p = 0.005). Age of patients was associated with both postoperative complication (p = 0.012, p = 0.044) and mortality (p = 0.013, p = 0.034). Univariate analysis showed that HSP was associated with postoperative complication (p = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.
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Affiliation(s)
- Ren Chongxi
- Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, China
| | - Ji Jinggang
- Department of General Surgery, Cangzhou People’s Hospital, China
| | - Shi Yan
- Department of General Surgery, Gucheng County People’s Hospital, China
| | - Wang Hongqiao
- Department of General Surgery, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, China
| | - Liu Yan
- Department of Pathology, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, China
| | - Yang Fengshuo
- Department of General Surgery, Cangzhou People’s Hospital, China
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Kanwal D, Attia KME, Fam MNA, Khalil SMF, Alblooshi AM. Stercoral perforation of the rectum with faecal peritonitis and pneumatosis coli: A case Report. J Radiol Case Rep 2017; 11:1-6. [PMID: 28584566 DOI: 10.3941/jrcr.v11i3.3060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Colonic perforation due to impacted faeces or faecaloma is a relatively uncommon presentation with grave prognosis. If left untreated, it can be life threatening due to complications like faecal peritonitis. Till date, fewer than 150 cases have been reported mostly in the English surgical literature describing constipation as the most common underlying etiology. Involvement of rectum is rare with very limited data published in this context. We present a case of stercoral perforation involving the rectum with associated faecal peritonitis and pneumatosis coli.
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Affiliation(s)
- Darakhshan Kanwal
- Department of Radiology, Sharjah Kuwait Hospital, United Arab Emirates
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Davies A, Webber K. Stercoral Perforation of the Colon: A Potentially Fatal Complication of Opioid-Induced Constipation. J Pain Symptom Manage 2015; 50:260-2. [PMID: 25847850 DOI: 10.1016/j.jpainsymman.2015.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/09/2015] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
Abstract
Stercoral perforation of the colon is a rare complication of constipation, and there have only been a few reported cases of stercoral perforation of the colon secondary to opioid-induced constipation. This article describes such a case in a cancer survivor with chronic cancer-related pain and reviews the medical/surgical literature on stercoral perforation of the colon.
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Affiliation(s)
- Andrew Davies
- Royal Surrey County Hospital, Guildford, Surrey, United Kingdom.
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Saksonov M, Bachar GN, Morgenstern S, Zeina AR, Vasserman M, Protnoy O, Benjaminov O. Stercoral Colitis. J Comput Assist Tomogr 2014; 38:721-6. [DOI: 10.1097/rct.0000000000000117] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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