Treatment of Stercoral Colitis
The treatment of stercoral colitis requires urgent intervention with a multimodal bowel regimen, fluid resuscitation, and surgical consultation, as this condition carries significant mortality risk especially when complicated by sepsis or perforation. 1, 2
Initial Management
- Fluid resuscitation: Aggressive IV fluid therapy to correct dehydration and electrolyte imbalances 2
- Bowel decompression:
- Enemas
- Oral laxatives
- Manual disimpaction of stool 3
- Antibiotic therapy: Initiate parenteral antibiotics if signs of infection or sepsis are present 2
- Venous thromboembolism prophylaxis: Subcutaneous low-molecular-weight heparin to reduce risk of thromboembolism 4
- Nutritional support: Enteral nutrition if malnourished (associated with fewer complications than parenteral nutrition) 4
Monitoring and Assessment
- Vital signs monitoring (at least four times daily)
- Daily abdominal radiography if colonic dilatation is present (transverse colon diameter >5.5 cm)
- Laboratory monitoring every 24-48 hours:
- Complete blood count
- C-reactive protein or ESR
- Serum electrolytes
- Liver function tests
- Serum albumin 4
- Blood transfusion to maintain hemoglobin above 8-10 g/dl 4
Surgical Management
- Surgical consultation: All patients with stercoral colitis should have early surgical evaluation 2
- Indications for urgent surgery:
- Signs of perforation
- Peritonitis
- Septic shock
- Failure to respond to conservative management 1
- Surgical procedure: Extended colectomy with diversion (Hartmann's procedure) is the mainstay of therapy for complicated stercoral colitis 1
Special Considerations
- Medication adjustments: Withdrawal of anticholinergic, anti-diarrhoeal, non-steroidal anti-inflammatory, and opioid drugs that may precipitate colonic dilatation 4
- Multidisciplinary approach: Collaboration between emergency physicians, gastroenterologists, and colorectal surgeons 4, 2
- Hospital admission: Should be considered for all patients with stercoral colitis due to high risk of complications 2, 5
Pitfalls to Avoid
- Delayed diagnosis: Patients may present without typical symptoms; maintain high clinical suspicion, especially in high-risk patients (elderly, chronic opioid users, mentally impaired) 1, 5
- Inadequate treatment: Over half of discharged patients in one study received no enema, laxatives, or disimpaction, potentially leading to complications 5
- Failure to recognize complications: Stercoral colitis can rapidly progress to ischemic colitis, perforation, and septic shock with high mortality 3
- Underestimating severity: Non-perforated stercoral colitis with septic shock may have higher mortality than perforated cases 1
Early recognition and aggressive management of stercoral colitis are essential to prevent life-threatening complications and reduce mortality.