Stercoral colitis is an inflammatory condition in which feces collect and cause pressure to build up within the colon. The condition is rare, but it can be severe and sometimes fatal. It occurs when chronic constipation leads to fecal impaction, clonic distension, deformation, and the development of masses of dehydrated fecal material called fecalomas. The fecalomas became lodged within areas of the colon, most common in the rectosigmoid colon.
What is it?
The blockage creates pressure increases that can cause ulcers to develop. These ulcers may lead to focal ischemic necrosis, which reduces blood flow to tissues, and colonic perforation, where a whole forms in the colon. These complications can be fatal, particularly if the colon perforates.
People with chronic constipation are more likely to develop Stercoral colitis. Stercoral colitis is more likely to affect older people and people with dementia.
Symptoms
These symptoms include:
Cramps
Fever
Anorectal pain
People with Stercoral colitis may experience abdominal distension where the belly swells noticeably.
The risk factors for Stercoral
Stercoral colitis most often occurs in patients with a history of chronic constipation, elderly patients with dementia, nursing home or bedbound patients, and occasionally young patients with psychiatric conditions. Chronic constipation is the biggest risk factor for developing Stercoral colitis.
Causes
Stercoral colitis results from increased pressure in the colon due to fecal impaction. Fecal impaction is the inability to pass large, hard, or thickened stool from the lower gastrointestinal tract. If people with chronic constipation are physically inactive, it may be harder to pass stool.
Epidemiology:
It is seen primarily in elderly patients. Less frequently, it may also be seen in younger patients who have metabolic, neurologic, and/or muscular disorders causing constipation.
Pathology:
Faecaloid formation is predominantly related to chronic constipation which leads to the development of fecaloma, which is a conglomeration of dehydrated fecal material. This causes distension of the colonic lumen and increases the pressure on the wall, which then decreases blood supply.
Diagnosis
It is not possible to diagnose Stercoral colitis based on physical examination and lab results alone. Imaging is necessary to make a diagnosis.
Doctors diagnose Stercoral colitis if a person has:
Fecal impaction
Colonic dilation, where the colon widens due to the buildup of stool
An increase in fat around the colon
Air moving from the opening of the bowels into or beyond the colon wall
It is necessary to diagnose Stercoral colitis as possible because it may lead to complications such as colonic perforation.
Treatment
The treatment involves removing the blockage. Removing the blockage may involve:
Using enemas
Placing a rectal tube
Manually dis-impacting the blockage
Surgery is another option for those who are at risk of complications, such as bowel perforation.
Complications
The most common serious complication of Stercoral colitis is perforation, which is considered a significant predictor of mortality. Other complications to be aware of are sepsis and septic shock, ischemic colitis, as well as urinary retention secondary to compression by dilated bowel. Multinitrogen failure can result in secondary to extrinsic compression and obstruction of ureters. Patients who are managed non-operatively can have a recurrence of ulcerations and resulting perforation in the segments of the colon that were affected. Patients who are managed operatively can develop leakage of anastomosis and resulting sepsis.
