Treatment of Stercoral Colitis
The treatment of stercoral colitis requires prompt intervention with fluid resuscitation, a multimodal bowel regimen, and surgical consultation for potential complications such as perforation, peritonitis, or sepsis. 1
Initial Management
Emergency Department Care
- Fluid resuscitation: Correct dehydration and electrolyte abnormalities 1, 2
- Bowel regimen initiation:
- Enemas
- Oral and/or rectal laxatives
- Manual disimpaction when necessary 2
- Pain management: Multimodal approach avoiding opioids that can worsen constipation
- Antibiotics: Consider initiating parenteral antibiotics if signs of infection are present 1
Monitoring and Supportive Care
- Venous thromboembolism prophylaxis with low-molecular-weight heparin 3
- Correction of electrolyte abnormalities and anemia 3
- Nutritional assessment and support for undernourished patients 3
Surgical Management
Indications for Surgical Intervention
- Perforation with peritonitis (requires immediate surgical intervention) 3, 4
- Hemodynamic instability or signs of shock 3
- Bowel necrosis 4
- Failed conservative management with persistent sepsis 3, 4
Surgical Procedures
- Colectomy with diversion (Hartmann's procedure) is the mainstay of therapy for complicated cases 4
- Extended left colectomy may be necessary depending on the extent of disease 4
Hospitalization Criteria
Hospital admission should be considered for all patients with stercoral colitis due to the high risk of complications and mortality 1, 2. Research indicates a 3.3% mortality rate within 3 months from causes related to stercoral colitis 2.
Special Considerations
High-Risk Populations
- Elderly patients
- Nursing home residents
- Chronic opioid users
- Patients with mental impairment or intellectual disability 4, 5
- Recent surgery patients 5
Diagnostic Pearls
- CT scan is the most helpful imaging modality for diagnosis 5
- Key CT findings include:
- Colonic dilatation with impacted feces
- Mural thickening
- Pericolic fat stranding 5
Follow-up Care
- Prevention of recurrence through ongoing bowel regimen
- Patient education on adequate fluid intake
- Avoidance of medications that cause constipation when possible
- Regular follow-up to ensure resolution and prevent recurrence
Common Pitfalls
Failure to recognize the condition: Stercoral colitis often presents with nonspecific symptoms, and abdominal pain may be absent in up to 62.1% of cases 2
Inadequate treatment: Over half of patients discharged from the ED receive no enema, laxatives, or disimpaction, potentially leading to complications 2
Delayed surgical consultation: Failure to involve surgical specialists early in cases with signs of perforation or sepsis can lead to increased mortality 4
Underestimating severity: Despite being rare, stercoral colitis has substantial short-term mortality and requires aggressive management 2
The management of stercoral colitis requires a high index of clinical suspicion, prompt diagnosis with appropriate imaging, and aggressive treatment to prevent life-threatening complications such as perforation, peritonitis, and sepsis.