From the Research
Stercoral colitis is a serious inflammatory condition of the colon that requires prompt medical attention to prevent life-threatening complications, and treatment should focus on relieving the fecal impaction and managing related complications, as recommended by the most recent study 1.
Key Points
- Stercoral colitis is a rare but serious diagnosis associated with a high rate of morbidity, as highlighted in a recent review 1.
- The condition typically occurs in chronically constipated patients, particularly the elderly, bedridden, or those with decreased mobility, and can lead to pressure necrosis, ulceration, and potentially life-threatening complications like perforation and peritonitis 2.
- Treatment focuses on relieving the fecal impaction through gentle enemas, manual disimpaction, or oral laxatives like polyethylene glycol, and intravenous fluids are often needed for rehydration 3.
- Antibiotics, such as piperacillin-tazobactam or a combination of metronidazole with a fluoroquinolone, are necessary if perforation or infection is suspected, and pain management with appropriate analgesics is important 4.
- Prevention involves maintaining regular bowel habits through adequate hydration, fiber intake, physical activity, and appropriate laxative use in high-risk patients, and prompt medical attention is crucial if symptoms like severe abdominal pain, distension, fever, or rectal bleeding develop, as these may indicate complications requiring urgent surgical intervention 5.
Management
- The diagnosis of stercoral colitis can be secured with cross-sectional radiography, including computed tomography of the abdomen and pelvis, which can reveal key findings such as fecaloma, colonic dilatation, and fat stranding 1.
- ED management includes fluid resuscitation, initiation of a multimodal bowel regimen, and if indicated, initiation of parenteral antibiotics and consultation with a surgical specialist 1.
- Admission to the hospital should be considered for all patients with stercoral colitis, as the condition can be associated with significant morbidity and mortality if not recognized and managed promptly 2.