From the Research
Treatment of a severe stercoral ulcer requires prompt surgical intervention, typically involving removal of the impacted fecal mass and repair of the ulcer, as seen in a recent case report from 2023 1. The primary treatment approach should focus on surgical management to prevent further complications such as perforation and peritonitis. Prior to surgery, patients should be stabilized with:
- Intravenous fluids
- Antibiotics, such as piperacillin-tazobactam 4.5g IV every 8 hours or a combination of ceftriaxone 2g daily and metronidazole 500mg every 8 hours
- Pain management Post-operative care should include bowel management protocols to prevent recurrence, such as:
- Stool softeners like docusate sodium 100mg twice daily
- Osmotic laxatives such as polyethylene glycol 17g daily
- A high-fiber diet For patients who are not surgical candidates, conservative management may be attempted with fecal disimpaction, aggressive bowel regimens, and close monitoring, though this carries a higher risk of complications, as noted in a study from 2017 2. Long-term prevention focuses on treating chronic constipation through dietary modifications, adequate hydration, and regular physical activity, highlighting the importance of addressing the underlying cause of stercoral ulcers, as discussed in a case report from 2002 3. It is essential to prioritize surgical intervention due to the high risk of mortality associated with stercoral ulcers, especially in older adults, as reported in a study from 1990 4. The most recent and highest quality study from 2023 1 supports the need for prompt surgical intervention to manage severe stercoral ulcers effectively and prevent life-threatening complications.