From the Research
Treatment for stercoral colitis should involve a combination of medical management, including fluid resuscitation, initiation of a multimodal bowel regimen, and if indicated, initiation of parenteral antibiotics, with consideration for surgical intervention in severe cases, as recommended by the most recent study 1. The management of stercoral colitis is crucial to prevent complications such as bowel ulceration, ischemia, perforation, peritonitis, and sepsis.
- Initial treatment focuses on relieving fecal impaction through manual disimpaction, enemas, and oral laxatives.
- Intravenous fluids are administered to correct dehydration and electrolyte imbalances.
- Pain management with acetaminophen or opioid-sparing analgesics may be required.
- Broad-spectrum antibiotics are indicated if infection is suspected or confirmed.
- Patients should be closely monitored for signs of perforation, including worsening abdominal pain, fever, or peritoneal signs.
- In cases with perforation, significant bleeding, or clinical deterioration despite medical management, urgent surgical consultation is necessary, potentially leading to colonic resection with colostomy, as supported by studies 2, 3. The diagnosis of stercoral colitis can be secured with cross-sectional radiography, including computed tomography of the abdomen and pelvis, which can help identify key findings such as fecaloma, colonic dilatation, and fat stranding 4, 5. Following resolution of the acute episode, prevention of recurrence is crucial through increased dietary fiber, adequate hydration, regular physical activity, and a bowel regimen that may include stool softeners or osmotic laxatives. This comprehensive approach addresses the underlying fecal impaction while preventing complications from pressure necrosis of the colonic wall caused by hardened stool masses. Admission to the hospital should be considered for all patients with stercoral colitis, as recommended by the most recent study 1.