Stercoral colitis complicated with ischemic colitis: a double-edge sword.
BACKGROUND
Stercoral colitis is a rare inflammatory process involving the colonic wall secondary to fecal impaction with high morbidity and mortality; especially if complicated with ischemic colitis, stercoral ulcer formation and subsequent perforation. There are several case reports published on abdominal perforation resulting from stercoral colitis. However, stercoral colitis complicated by ischemic colitis is rare. The purpose of this case report is to describe the potential challenges in the diagnosis and management of stercoral colitis with ischemic colitis.


CASE PRESENTATION
An 87 years old male with history of chronic constipation presents with severe abdominal pain to the emergency department. The patient was hemodynamically stable. On physical examination, the abdomen was mildly distended with moderate tenderness. Lab work was significant for leukocytosis and lactic acidosis. Abdominal CT scan revealed large amount of retained stool in the colon, bowel wall thickening and infiltration of peri-colonic fat, which were suggestive for stercoral colitis. Patient was started on IV fluids and antibiotics. He was given an enema, followed by laxative and manual disimpaction of stool. Colonoscopy was performed and biopsies were obtained. Tissue biopsy was significant for focal active colitis with regenerative glandular changes and neural hyperplasia.


CONCLUSION
Elevated lactic acid level secondary to ischemia of the bowel wall with CT scan findings aid in establishing the diagnosis of stercoral colitis complicated with ischemic colitis. Urgent treatment with laxatives and fecal disimpaction is indicated to prevent perforation and peritonitis.
['Naseer|Maliha|M|', 'Gandhi|Jenil|J|', 'Chams|Noor|N|', 'Kulairi|Zain|Z|']
D000140:Acidosis, Lactic D000369:Aged, 80 and over D001706:Biopsy D003092:Colitis D017091:Colitis, Ischemic D003113:Colonoscopy D005244:Fecal Impaction D006801:Humans D054368:Laxatives D007964:Leukocytosis D008297:Male D014057:Tomography, X-Ray Computed
Stercoral colitis Ischemic colitis Chronic constipation Lactic acidosis