From the Research
The treatment for stercoral colitis involves a combination of conservative management and, in severe cases, surgical intervention, with the most recent and highest quality study 1 emphasizing the importance of prompt and appropriate management to prevent adverse outcomes. The initial treatment focuses on relieving fecal impaction through manual disimpaction, enemas, and oral laxatives such as polyethylene glycol, lactulose, or mineral oil. Intravenous fluids are administered to correct dehydration and electrolyte imbalances. Pain management with appropriate analgesics is important for patient comfort. Broad-spectrum antibiotics (such as piperacillin-tazobactam, ceftriaxone plus metronidazole, or ciprofloxacin plus metronidazole) are typically given to prevent or treat secondary infections. Some key points to consider in the management of stercoral colitis include:
- The importance of early recognition and diagnosis, as highlighted in 2 and 3
- The need for careful monitoring for signs of perforation or peritonitis, which would necessitate emergency surgery, as noted in 4 and 5
- The role of surgical intervention in cases with perforation, significant bleeding, or clinical deterioration despite conservative management, typically involving resection of the affected colon segment with either primary anastomosis or temporary colostomy, as discussed in 4 and 1
- The importance of prevention of recurrence through increased dietary fiber (25-30g daily), adequate hydration (at least 2 liters of fluid daily), regular physical activity, and sometimes maintenance laxative therapy, as emphasized in 2, 3, and 1 This comprehensive approach addresses the immediate complication while preventing future episodes by targeting the underlying chronic constipation. Given the potential for severe complications and the importance of prompt management, it is crucial to prioritize the treatment of stercoral colitis based on the most recent and highest quality evidence, such as the study by 1.