Stercoral perforation as a catastrophic complication of constipation

Stercoral perforation is a complication of fecal impaction with a high mortality. It is not well known by physicians, which leads to an underestimation of its incidence and thus an often late diagnosis. The treatment of choice is an early operation with resection of the affected colon, an end colostomy and closure of the rectum (Hartmann's procedure), in combination with extensive lavage and broadspectrum antibiotics. The case of a 55-year-old patient with a long history of constipation and fecal impaction presenting with diffuse peritonitis is discussed. On a CT-scan, free air was seen and a sigmoidal perforation was suspected. During the laparotomy, a stercoral perforation of the sigmoid was found with multiple fecalomas in the colon. This patient had multiple risk factors for constipation and stercoral perforation including the use of aspirin, codeine and non-steroidal anti-inflammatory drugs (NSAIDs), as well as anorexia nervosa, a poor general health, weak abdominal press due to atrophic abdominal muscles and genital prolapse with a pessary in place. This case aims to highlight stercoral perforation and its possible risk factors to better identify risk patients, in the hope to prevent this complication. Furthermore, a review of the literature is presented in which the published cases of the last decennium are analysed using the Maurer criteria.

Jaar van publicatie:2012