Figure 1
pelvic abscesses and sigmoid perforation
AXIAL MDCT contrast-enhanced showed perforation of sigmoid colon due to breaking of faecalomas
Acute abdomen caused by stercoral perforation
SectionAbdominal imaging
Case TypeClinical Cases
Authors
Rosa CF.
Azienda Ospedaliera-Universitaria, Department of Emergency Radiology, Ospedale S.Martino, Genoa, Italy.
Connected authors
83 years, female
Clinical History
The patient presented with vomiting, cronic constipation and severe abdominal pain. Suspected diagnosis of stercoral perforation was made by MDCT confirmed after laparotomy. The patient died 1 day later.
Imaging Findings
The 83 year old female patient presented at our department with vomiting, with severe abdominal pain, intra-abdominal sepsis and chronic constipation.
The abdomen was rigid, little tractability, Blumberg positive; at the rectal exploration mucus and blood was found. MDCT performed later showed a faecal distension of colon, the presence of multiple abscesses in pelvis and sigmoid perforation caused by the breaking of faecalomas. The surgical treatment was multiple segmentary resection of colon, splenectomy and temporary colostomy. The patient died after heart failure 1 day later.
The abdomen was rigid, little tractability, Blumberg positive; at the rectal exploration mucus and blood was found. MDCT performed later showed a faecal distension of colon, the presence of multiple abscesses in pelvis and sigmoid perforation caused by the breaking of faecalomas. The surgical treatment was multiple segmentary resection of colon, splenectomy and temporary colostomy. The patient died after heart failure 1 day later.
Discussion
Stercoral perforation is a rare event: the frequency is high in the sigmoid and rectum-sigmoid junction (77%) for the hypoperfusion of the antimesenteric border and the diameter of the viscerum.
It happens mostly in old patients than in younger people with neurological defects. Mechanical obstruction, motility disorder, megacolon, foreign bodies ingestion, barium enema exams, gallstones and the use of narcotics, tranquilizers, NSAIDs, antidepressants are the major predisposing factors. The presence of large and stone-hard faecalomas causes deformity of colon and creates a pressure that leads to bowel-wall necrosis, ischemia, ulceration and subsequent perforation. The mortality is 35%.
It happens mostly in old patients than in younger people with neurological defects. Mechanical obstruction, motility disorder, megacolon, foreign bodies ingestion, barium enema exams, gallstones and the use of narcotics, tranquilizers, NSAIDs, antidepressants are the major predisposing factors. The presence of large and stone-hard faecalomas causes deformity of colon and creates a pressure that leads to bowel-wall necrosis, ischemia, ulceration and subsequent perforation. The mortality is 35%.
Differential Diagnosis List
STERCORAL PERFORATION
Final Diagnosis
STERCORAL PERFORATION
References
[1] Carter DC, Kirkpatrick JR (1973) Stercoral perforation of the sigmoid colon. Br J Surg 60(1):61-3. (PMID: 4685924)
[2] Heffernan C, Pachter HL, Megibow AJ, Macari M (2005) Stercoral Colitis Leading to Fatal Peritonitis: CT Findings. AJR Am J Roentgenol 184:11891193. (PMID: 15788592)
[3] Dubinsky I (1996) Stercoral Perforation of the colon: case report and review of literature. J Emerg Med 14(3):323-5. (PMID: 8782027)
[4] Huang WS, Wang CS, Hsieh CC, Lin PY, Chin CC, Wang JY (2006) Management of patients with stercoral perforation of the sigmoid colon: Report of five cases. World J Gastroenterol 12(3): 500-503. (PMID: 16489660)
Case information
| URL: | https://www.eurorad.org/case/7756 |
| DOI: | 10.1594/EURORAD/CASE.7756 |
| ISSN: | 1563-4086 |
Figure 2
peritonitis in multiple descending colon faecalomas
MPR MDCT contrat-enhanced
showed multiple descending colon faecalomas and peritonitis
Figure 3
pelvic abscesses and sigmoid perforation
MPR MDCT contrast-enhanced showed sigmoid perforation due to breaking of faecalomas
Figure 4
sigmoid faecalomas
sigmoid faecalomas after the laparotomy
Figure 5
multiple segmentary resection of colon
the performed laparotomy showed bowel-wall necrosis, ischaemia, peritonitis and sigmoid perforation due to breaking of faecalomas
pelvic abscesses and sigmoid perforation
AXIAL MDCT contrast-enhanced showed perforation of sigmoid colon due to breaking of faecalomas
peritonitis in multiple descending colon faecalomas
MPR MDCT contrat-enhanced
showed multiple descending colon faecalomas and peritonitis
pelvic abscesses and sigmoid perforation
MPR MDCT contrast-enhanced showed sigmoid perforation due to breaking of faecalomas
sigmoid faecalomas
sigmoid faecalomas after the laparotomy
multiple segmentary resection of colon
the performed laparotomy showed bowel-wall necrosis, ischaemia, peritonitis and sigmoid perforation due to breaking of faecalomas