STERCORAL PERFORATION OF THE COLON: A RARE BUT LETHAL COMPLICATION – CASE REPORT AND LITERATURE REVIEW danielbarocio03@gmail.com

PE090

STERCORAL PERFORATION OF THE COLON: A RARE BUT LETHAL COMPLICATION – CASE REPORT AND LITERATURE REVIEW

5

 

 

 

 

Mexico

Poster Exhibition only

Stercoral perforation is a rare complication secondary to chronic constipation, resulting in ischemic necrosis of the colonic wall. It accounts for 1.2% of emergency colorectal surgeries and 3.2% of all large bowel perforations. Most cases (≈90%) occur in the sigmoid and rectosigmoid colon, followed by the cecum (9%), usually on the antimesenteric border. Risk factors include chronic constipation, immobility, and medications such as opioids, antidepressants, NSAIDs, and antipsychotics. Clinical manifestations are nonspecific, making preoperative diagnosis difficult. Maurer’s intraoperative criteria include: (1) round/ovoid perforation >1 cm on the antimesenteric border, (2) fecalomas protruding through the perforation or in the abdominal cavity, (3) necrotic and inflamed edges macroscopically, and (4) histologic evidence of stercoral ulcer.

A 31-year-old male with schizophrenia and bipolar disorder presented with a two-month history of constipation, severe abdominal pain, and distension, worsening in the hours prior to admission. CT revealed massive colonic dilatation with fecal loading, pneumoperitoneum, and free fluid. Emergency laparotomy showed generalized fecal peritonitis, multiple necrotic patches along the colon, and a 1 cm antimesenteric perforation in the sigmoid.

Total colectomy and peritoneal lavage were performed. Postoperatively, the patient remained unstable, requiring vasopressors and mechanical ventilation. He suffered cardiopulmonary arrest and died in the immediate postoperative period.

Stercoral perforation is associated with high mortality due to severe fecal peritonitis. Early recognition, prompt surgical intervention, and aggressive supportive care are crucial. A high index of suspicion is warranted in patients with chronic constipation, immobility, advanced age, or high-risk medication use