Treatment for Stercoral Colitis
The treatment for stercoral colitis requires immediate fecal disimpaction, aggressive bowel regimen, fluid resuscitation, and monitoring for complications such as perforation and sepsis. 1
Understanding Stercoral Colitis
Stercoral colitis is a rare but serious inflammatory condition of the distal large bowel and rectum resulting from accumulation of impacted stool. It is associated with several potentially life-threatening complications:
- Bowel ulceration
- Ischemia
- Perforation
- Peritonitis
- Sepsis
Diagnostic Approach
Before initiating treatment, confirm the diagnosis with:
Imaging: CT scan of abdomen and pelvis is the most helpful imaging modality showing:
- Colonic dilatation with impacted feces
- Mural thickening
- Pericolic fat stranding
- Possible free fluid in severe cases 2
Laboratory tests:
- Complete blood count (look for leukocytosis)
- Comprehensive metabolic panel
- Lactic acid levels (may be elevated due to bowel wall ischemia) 3
Treatment Algorithm
1. Initial Management (All Patients)
- Fluid resuscitation: Correct dehydration and electrolyte imbalances
- Bowel disimpaction:
- Enemas
- Manual disimpaction if necessary
- Colonoscopic disimpaction for severe cases 4
- Multimodal bowel regimen:
- Stool softeners
- Osmotic laxatives
- Stimulant laxatives
2. For Patients with Signs of Infection or Inflammation
- Antibiotic therapy: Broad-spectrum antibiotics covering gram-negative and anaerobic bacteria
- Monitor for sepsis: Frequent vital sign checks and laboratory monitoring
3. For Patients with Suspected Ischemia
- Close monitoring for signs of deterioration
- Surgical consultation for potential intervention
- Serial lactic acid measurements to track ischemia 3
4. For Patients with Perforation or Peritonitis
- Immediate surgical consultation
- NPO status
- Broad-spectrum antibiotics
- Possible emergency surgery
Special Considerations
- Elderly patients and those with neurological disorders (cerebral palsy, dementia, etc.) require special attention as they may present with altered mental status rather than typical abdominal symptoms 4
- Hospitalization should be considered for all patients with stercoral colitis due to the high risk of complications 1
- Post-resolution maintenance therapy should include:
- Long-term bowel regimen
- Increased fluid intake
- Dietary modifications to prevent recurrence
Common Pitfalls to Avoid
- Delayed diagnosis: Maintain high clinical suspicion in high-risk patients, especially those with chronic constipation
- Inadequate disimpaction: Partial disimpaction may not resolve the inflammatory process
- Missing complications: Regular reassessment is crucial to detect early signs of perforation or sepsis
- Overlooking underlying causes: Address the root cause of chronic constipation to prevent recurrence
The mortality rate of stercoral colitis can be high, particularly when complicated by perforation, making prompt recognition and aggressive management essential to improve patient outcomes 5.