From the Research
Stercoral colitis typically does not require antibiotics as primary treatment, and the mainstay of therapy focuses on relieving fecal impaction through manual disimpaction, enemas, and stool softeners. The underlying pathophysiology of stercoral colitis involves pressure necrosis from hardened stool against the colonic wall, not primarily bacterial infection 1. According to the most recent study in 2025, stercoral colitis is a rare but serious diagnosis associated with a high rate of morbidity, and its management in the emergency department includes fluid resuscitation, initiation of a multimodal bowel regimen, and if indicated, initiation of parenteral antibiotics and consultation with a surgical specialist 1.
Key Considerations
- Antibiotics are only indicated if there are signs of bacterial infection such as fever, elevated white blood cell count, or evidence of perforation 2, 3.
- In cases where antibiotics are needed, broad-spectrum coverage like piperacillin-tazobactam 3.375g IV every 6 hours or ciprofloxacin 500mg orally twice daily plus metronidazole 500mg orally three times daily for 5-7 days may be used 2.
- Prevention of recurrence is crucial and involves addressing chronic constipation through increased fluid intake, dietary fiber, regular exercise, and sometimes scheduled laxatives 4, 3.
- Patients should be monitored for complications like perforation, which would require immediate surgical intervention 5, 3.
Management Approach
- The diagnosis of stercoral colitis can be secured with cross-sectional radiography, including computed tomography of the abdomen and pelvis 1, 4.
- CT findings that should prompt the radiologist to consider this diagnosis include colonic dilatation containing impacted feces, mural thickening, and pericolic fat stranding 4.
- Admission to the hospital should be considered for all patients with stercoral colitis, especially if there are signs of complications or severe disease 1, 3.