Stercoral colitis is a severe inflammatory bowel condition characterized by inflammation of the colon wall caused by excessive pressure from a mass of hardened fecal matter. This process arises from chronic, severe constipation and can lead to significant tissue damage. It is considered a medical emergency requiring immediate attention.
Defining Stercoral Colitis
The term “stercoral” is derived from the Latin word for feces. Stercoral colitis develops when chronic, severe constipation allows stool to become dehydrated and compressed into a rock-hard mass known as a fecaloma, typically lodging in the rectosigmoid colon.
This hardened mass exerts constant pressure against the colon wall, compromising blood flow to the affected area, a state known as ischemia. Reduced blood supply prevents oxygen and nutrients from reaching the tissue, leading to pressure necrosis (death of colon wall cells) and subsequent ulceration.
The most serious outcome is stercoral perforation, where the dead tissue creates a hole in the colon wall. Perforation spills intestinal contents into the abdominal cavity, leading to peritonitis and widespread infection (sepsis), which is a life-threatening surgical emergency with high mortality rates.
Identifying Key Risk Factors
Several factors increase the likelihood of severe impaction occurring. Advanced age is a primary risk factor, as older adults often experience slower intestinal movement and reduced sensation of needing to defecate. Immobility, particularly in bedridden patients, slows down the muscle contractions (peristalsis) that move stool through the colon.
Certain medications can significantly impair bowel function. Opioid pain relievers are a major cause because they slow gut motility and increase fluid absorption, resulting in harder stool. Anticholinergic drugs and some calcium channel blockers also reduce the movement of the intestinal muscles.
Neurological disorders, such as dementia, stroke, and Parkinson’s disease, can disrupt the nerve signals necessary for normal bowel movements. Inadequate intake of dietary fiber and insufficient fluid consumption are also contributing factors. These elements create a vicious cycle where slow transit leads to harder stool and greater risk of impaction.
Clinical Presentation and Diagnosis
The symptoms often begin with severe, persistent abdominal pain, frequently localized to the lower left quadrant where the sigmoid colon is located. Patients may also experience abdominal distension, nausea, and vomiting due to the obstruction caused by the impacted mass. A confusing symptom is paradoxical diarrhea, where liquid stool manages to leak around the obstruction.
Physical examination may reveal a tender, rigid abdomen, and sometimes a hard mass can be felt upon palpation. Medical professionals must confirm the diagnosis quickly.
Definitive diagnosis relies heavily on imaging studies, as the clinical presentation can mimic other abdominal emergencies. Computed Tomography (CT) scanning is the preferred imaging modality because it clearly visualizes the key features of the condition.
A CT scan will show a large, impacted fecal mass, often with signs of inflammation such as thickening of the colon wall. The imaging can also detect perforation, which appears as free air or fluid within the abdominal cavity. The CT scan is instrumental in differentiating stercoral colitis from other conditions that cause colon inflammation, such as diverticulitis.
Treatment and Management Strategies
The management of stercoral colitis is centered on two main pathways: non-operative disimpaction for stable patients and immediate surgery for complicated cases. Initial non-operative treatment aims to gently remove the fecaloma and includes the use of enemas, often mineral oil or water-soluble contrast enemas, to soften the mass and lubricate the colon.
Oral laxatives, such as polyethylene glycol, may be used cautiously in less severe cases to promote evacuation. If the impaction is severe, manual disimpaction is necessary, involving a healthcare provider physically removing the stool from the rectum, usually requiring sedation. Close monitoring is carried out during these procedures to watch for any signs of perforation.
Surgical intervention is required immediately if the patient shows signs of perforation, peritonitis, or sepsis, or if non-operative measures fail to relieve the obstruction. Surgical management involves removing the diseased section of the colon and often creating a temporary or permanent colostomy.
Following resolution of the acute episode, long-term management prevents recurrence by focusing on optimizing diet, ensuring adequate hydration, and increasing daily fiber intake to between 25 and 30 grams. Medications that contributed to the constipation, such as opioids or anticholinergics, are carefully reviewed and adjusted to maintain regular bowel function.