Korean J Gastroenterol.  2010 Jan;55(1):46-51. 10.4166/kjg.2010.55.1.46.

Clinical Analysis of Stercoral Perforation of the Colon

• Nam JK
• Kim BS
• Kim KS
• Moon DJ

• KMID: 1775925
• DOI: http://doi.org/10.4166/kjg.2010.55.1.46

Abstract

BACKGROUND/AIMS
A stercoral perforation of the colon (SPC) is a rare, life-threatening disease. The aim of this study was to represent the definition of SPC and help the diagnosis and treatment of this condition.
METHODS
We reviewed 92 medical records of patients who underwent operation due to colonic perforation from January 2000 to February 2009 retrospectively. Maurer's diagnostic criteria were used for the diagnosis of SPC.
RESULTS
Eight patients (8.7%) were diagnosed as SPC. The age of the patients ranged from 59 to 85 years old. All of the patients were female and had a history of long-standing constipation. Only two patients (25%) were diagnosed as SPC preoperatively. The site of perforation of all patients was sigmoid colon. The methods of operation were Hartmann's procedure (7 cases), and primary repair with sigmoid loop colostomy (1 case). There were one recurrence and two deaths (25%) due to sepsis and multiple organ failure.
CONCLUSIONS
SPC should be considered in chronically constipated, and bedridden patients who present with acute abdomen. Hartmann's procedure is the treatment of choice in most situations. Mortality is high but can be minimized with early definitive surgery.

Keyword

Perforation, Stercoral; Perforation, Colonic; Constipation, Chronic

MeSH Terms

Aged
Aged, 80 and over
Colon, Sigmoid/pathology
Colonic Diseases/*diagnosis/radiography/surgery
Female
Humans
Intestinal Perforation/*diagnosis/radiography/surgery
Middle Aged
Postoperative Complications
Respiratory Distress Syndrome, Adult/etiology
Retrospective Studies
Sepsis/etiology
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. 68-year-old female with stercoral perforation of colon. (A) Transverse CT image showed fecaloma protruding through the wall defect of the sigmoid colon (arrowhead). (B) Transverse CT image obtained at upper level showed extra-luminal fecal material (arrow) and free gas (arrowhead).

• 

  Fig. 2. Microscopic findings of the colonic wall around the perforation. It showed clear-cut denudation of mucosa and submucosa with exposure of muscular layer. Marked vascular congestion and mild chronic inflammation were noted (H&E stain, ×100).

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