A stercoral perforation of the descending colon / 대한외과학회지

This is a case report on a stercoral perforation of the descending colon that was not adequately treated in the first operation. Re-operation was required in order to revise the primary repair site and to remove the impacted fecaloma.

A Case of Stercoral Perforation of Sigmoid Colon Diagnosed by Colonoscopy / 대한소화기내시경학회지

Stercoral perforation of the colon is a rare disease. Yet, in recent times, the number of reported cases has increased because of the growing elderly population. Stercoral perforation of the colon usually occurs in the elderly or bedridden patients with chronic constipation. Stercoral perforation may cause a massive hemorrhage or peritonitis. The prognosis of stercoral perforation is poor, as the reported postoperative mortality is 35~40%. So, early diagnosis and proper treatment are very important for improving survival. However, making an early diagnosis may be difficult because of the nonspecific initial symptoms. We experienced a case of stercoral perforation that was diagnosed by colonoscopy. The defect was in the sigmoid colon, and it was covered with peritoneum. The patient completely recovered after resection and anastomosis of the perforated colon. We report here on this case with a review of the relevant literature.

A Case of Stercoral Perforation of the Sigmoid Colon

A stercoral perforation of the colon is a rare phenomenon and is caused by severe prolonged constipation. Since the first reported case in 1894, approximately 80 additional cases have been reported. However, this rare condition seems to have been underestimated because of not only obscure diagnostic standards but also ignorance and failure to notice by surgeons. Due to its high mortality rate of about 35~40%, a stercoral ulcer perforation should be considered in any patient with chronic constipation who presents with peritonitis. We report a case of a 75-year-old female who was diagnosed as having a stercoral perforation of the sigmoid colon and review the clinical features, the diagnosis, and the treatment.

Stercoral Perforation of the Colon

A stercoral perforation of the colon is a very rare condition, which results from stercoral ulcers due to severe, prolonged constipation, and has a very high mortality rate. Herein is presented four cases of stercoral perforation of the sigmoid colon. All the patients were female. They had long standing and severe constipation, with peritonitis, prior to admission. Plain chest or abdominal X-rays revealed the presence of abdominal free air in all cases, and so emergent operations were undertaken. Fecalomas were found in the colon or abdominal cavity, with round and spherical shaped perforated sites. Microscopically, the edges of the ulcers were compressed with the accumulation of lymphocytes. A resection of the perforated colon with a proximal colostomy was performed in one case, a primary closure of the perforated colon and a proximal colostomy in another and a Hartmann's colostomy in the remaining two cases.

Clinical Analysis of Stercoral Perforation of Colon

PURPOSE: Stercoral perforation of colon is a rare disease with poor prognosis. But according to recent reports, the incidence of stercoral perforation in the colon seemed to have been underestimated. The reason might be the lack of recognition and overlook by surgeons. The purposes of this study were to represent the definition of stercoral perforation, and to help the diagnosis and treatment of stercoral perforation. METHODS: Among the patients who underwent emergency operation for colon perforation at the Department of Surgery, Korea University College of Medicine, from January 1992 to December 2001, 9 patients were diagnosed as stercoral perforation and their medical records were reviewed retrospectively regarding the clinical characteristics, managements and mortality. RESULTS: The age distribution of the patients was from 32 to 76 years. Male to female ratio was 1.3:1. All patients had history of chronic constipation. Six cases (33.3%) had free air, and 5 cases (55.6%) had fecaloma at preoperative simple X-ray. The site of perforation were sigmoid colon (8 cases) and descending colon (1 case). The size of perforation ranged from 1 cm to 6.5 cm (mean: 3.1 2.7 cm). The methods of operation were Hartmann's procedure (8 cases), primary repair and sigmoid loop colostomy (1 case). There were two deaths for sepsis. CONCLUSIONS: The stercoral perforation is not rare as commonly thought. If elderly patients who had history of chronic constipation and symptoms of panperitonitis visit hospital, surgeon should be aware of the possibility of this fatal disease and do early surgical intervention with the aggressive therapy for reducing the mortality.

Two Cases of Stercoral Perforation of Colon

While colon perforation as a complication of diseases such as carcinoma, colitis, diverticular disease, or abdominal trauma is not uncommon, spontaneous perforation of the colon is rare. Although spontaneous perforation is classified as either stercoral or idiopathic on the basis of its etiological background, the pathological mechanisms of the lesions have yet to be determined in detail. Stercoral perforation is a very rare cause of acute abdomen, with fewer than 70 cases documented in the literature; and idiopathic perforation is also infrequently reported. Both disease entities have often been grouped together as idiopathic or spontaneous perforation, resulting in confusion. We report herein two cases of stercoral perforation of the sigmoid colon. The clinical features, diagnosis, and treatment of the disease are reviewed. Surgeons should be aware of the possibility of this fatal disease, despite its rare incidence. Furthermore, it is important to recognize the condition at an early stage of the disease because it has significantly high mortality if surgery is delayed.