What is the treatment for stercoral colitis?

Treatment of Stercoral Colitis

The treatment of stercoral colitis requires immediate intervention with fecal disimpaction, aggressive bowel regimen, intravenous fluids, and antibiotics to prevent life-threatening complications such as perforation, sepsis, and death. 1, 2

Diagnosis and Initial Assessment

• Stercoral colitis is an inflammatory condition of the colon caused by fecal impaction, most commonly affecting nursing home patients, chronic opioid users, and patients with mental impairment 1
• Diagnosis is typically confirmed with CT scan showing:
  • Impacted fecal matter in a distended colon
  • Colonic wall thickening
  • Pericolic fat stranding
  • Free fluid in the abdomen 1, 3
• Laboratory findings often include leukocytosis and elevated lactic acid levels due to ischemia of the bowel wall 4

Medical Management

Immediate Interventions

• Intravenous fluid and electrolyte replacement to correct and prevent dehydration 5
• Initiation of parenteral antibiotics, particularly if signs of sepsis are present 2
• Blood transfusion to maintain hemoglobin >10 g/dl if bleeding is present 5
• Subcutaneous heparin for thromboprophylaxis, as inflammatory conditions increase thromboembolism risk 5

Fecal Disimpaction

• Enemas followed by laxatives for initial bowel evacuation 4
• Manual disimpaction of stool if necessary 4
• Colonoscopic fecal disimpaction for severe cases 6
• Multimodal bowel regimen to prevent recurrence 2

Monitoring

• Regular vital sign monitoring (at least four times daily) 5
• Daily abdominal radiography if colonic dilatation is present (transverse colon diameter >5.5 cm) 5
• Regular measurement of complete blood count, inflammatory markers, serum electrolytes, and liver function tests every 24-48 hours 5

Surgical Management

Indications for Emergency Surgery

• Free perforation and generalized peritonitis 5
• Massive bleeding with hemodynamic instability 5
• Clinical deterioration and signs of shock 5
• Septic shock despite medical management 1
• Transmural necrosis of the colon 1

Surgical Approach

• Subtotal colectomy with ileostomy is the surgical treatment of choice for severe cases 5
• Extended left colectomy and Hartmann's procedure may be appropriate depending on the location of pathology 1
• Joint management by gastroenterologist and colorectal surgeon is recommended for optimal outcomes 5

Special Considerations

• Patients with stercoral colitis complicated by ischemic colitis have higher morbidity and mortality rates 4
• Non-perforated stercoral colitis with septic shock may have higher mortality than perforated cases 1
• Altered mental status in patients with severe constipation should raise suspicion for stercoral colitis, especially in those with neurological disorders 6
• Nutritional support should be provided if the patient is malnourished 5

Prevention of Recurrence

• Aggressive bowel regimen maintenance after resolution 2
• Patient education regarding adequate hydration and fiber intake 2
• Regular bowel movement monitoring, especially in high-risk patients 3
• Avoidance of medications that cause constipation when possible 6

Prognosis

• Early detection and treatment significantly improve outcomes 6
• Complications include stercoral ulcer, perforation, ischemic colitis, sepsis, and death 1
• Hospital admission should be considered for all patients with stercoral colitis due to high risk of complications 2