What is the treatment for stercoral colitis?

Treatment of Stercoral Colitis

The treatment of stercoral colitis requires immediate fecal disimpaction, aggressive bowel regimen, and close monitoring for complications including perforation, ischemia, and sepsis. This inflammatory condition of the colon caused by fecal impaction demands prompt intervention to prevent potentially life-threatening complications.

Diagnosis and Assessment

• Imaging: CT scan is the most helpful diagnostic modality, showing:

  • Colonic dilatation with impacted feces
  • Mural thickening of the colon
  • Pericolic fat stranding
  • Possible free fluid in abdominal/pelvic cavities 1

• Laboratory evaluation:

  • Complete blood count (looking for leukocytosis)
  • Lactic acid levels (elevated in cases with ischemic component) 2
  • Electrolytes and renal function

Treatment Algorithm

Initial Management (Emergency Department)

1. Fluid Resuscitation

   • Intravenous fluid replacement to correct dehydration and electrolyte imbalances 3
   • Maintain adequate hydration to soften stool

2. Fecal Disimpaction

   • Enemas (phosphate, mineral oil)
   • Manual disimpaction if necessary 2
   • Consider colonoscopic disimpaction for severe cases 4

3. Multimodal Bowel Regimen

   • Stool softeners (docusate sodium)
   • Osmotic laxatives (polyethylene glycol, lactulose)
   • Stimulant laxatives (bisacodyl, senna) 3, 4

4. Antibiotic Therapy

   • Initiate broad-spectrum antibiotics if signs of infection or sepsis are present 5
   • Consider coverage for gram-negative and anaerobic organisms

Monitoring and Escalation

• Surgical Consultation

  • Early surgical consultation is essential for all patients with stercoral colitis 3
  • Urgent surgical intervention is required for:
    • Signs of perforation
    • Peritonitis
    • Septic shock
    • Bowel necrosis 5

• Surgical Management

  • Colectomy with diversion (Hartmann's procedure) for cases with perforation, necrosis, or sepsis unresponsive to medical management 5
  • Extended left colectomy may be necessary depending on the extent of disease

Prevention of Recurrence

• Long-term bowel regimen
• Increased fluid intake
• Dietary modifications (increased fiber)
• Regular physical activity
• Addressing underlying causes of constipation

Special Considerations

• High-Risk Populations:

  • Elderly patients
  • Nursing home residents
  • Chronic opioid users
  • Patients with neurological disorders or mental impairment 5
  • Recent surgery patients with limited mobility 1

• Complications to Monitor:

  • Colonic perforation
  • Peritonitis
  • Sepsis and septic shock
  • Bowel necrosis
  • Ischemic colitis 2

Pitfalls and Caveats

• Non-perforated stercoral colitis with septic shock may have higher mortality than perforated cases 5
• Patients with altered mental status or limited communication abilities may present with atypical symptoms, making diagnosis challenging 4
• Avoid anticholinergic, anti-diarrheal, NSAIDs, and opioid medications as they may worsen impaction or precipitate colonic dilatation 6
• Delayed diagnosis significantly increases morbidity and mortality rates 4

Hospital admission should be considered for all patients with stercoral colitis due to the high risk of complications and need for close monitoring 3.