Korean J Gastroenterol.  2020 Oct;76(4):191-198. 10.4166/kjg.2020.76.4.191.

Prognostic Factors of Patients with Stercoral Perforation of the Colon

• Lee HJ
• Kim KH
• Lee SC
• Song S

• KMID: 2507766
• DOI: http://doi.org/10.4166/kjg.2020.76.4.191

Abstract

Background/Aims
The incidence of stercoral perforation of the colon (SPC) is expected to rise, given the increased life expectancy and the aging population. On the other hand, the prognostic factors of mortality after surgery for SPC remain unclear. This study examined the prognostic factors of patients with SPC after surgery.
Methods
The medical records of 145 patients who underwent surgery for colonic perforation between April 2010 and May 2019 were reviewed retrospectively. In 145 patients, 22 patients who underwent SPC surgery were categorized into the following two groups according to in-hospital survival after surgery: alive (group A, n=15) and dead (group B, n=7).
Results
In all enrolled patients, the mean age was 75.7±9.0 years, with a female predominance (female patients, n=19, 86.4%). Sixteen patients (72.7%) had chronic constipation with medications, and five patients (22.7%) were bedridden. The rate of preoperative bedridden status was significantly higher in group B than group A (6.7% vs. 57.1%; p=0.021). Univariate analysis revealed immobility, a sequential organ failure assessment (SOFA) score, and lactate levels of more than 2.0 mmol/L to be factors associated with increased mortality rates in the postoperative period. Multivariate analysis revealed abnormal lactate levels to be the only factor related to mortality (hazard ratio 16.50, 95% CI 1.48-183.07, p=0.022).
Conclusions
Preoperative abnormal serum lactate levels may be a risk factor for mortality after surgery in patients with stercoral perforation. Further research will be needed to identify the postoperative prognostic SPC factors.

Keyword

Constipation; Emergency treatment; Lactic acid; Mortality

Figure

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  Fig. 1 (A) Preoperative computed tomography (CT) view of a 76-year-old female patient. This CT scan showed many fecalomas in the sigmoid colon (circle) and pneumoperitoneum around it (arrow). (B) Specimen of the same patient showed a 2 cm ovoid perforation in the sigmoid colon.

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