What Causes Stercoral Colitis
Stercoral colitis is caused by the accumulation of impacted fecal material in the colon, which leads to pressure-induced inflammation, ulceration, and potential ischemia of the colonic wall. 1, 2
Pathophysiologic Mechanism
The fundamental cause is fecal impaction that creates direct mechanical pressure on the colonic mucosa, resulting in:
- Pressure necrosis of the bowel wall from the impacted stool mass (fecaloma) 1, 3
- Compromised blood flow to the colonic wall, leading to ischemic changes and potential necrosis 4, 5
- Inflammatory response in the affected colonic segments, most commonly the distal large bowel, sigmoid colon, and rectum 2, 3
- Ulcer formation (stercoral ulcers) that can progress to perforation in severe cases 4, 5
High-Risk Patient Populations
Stercoral colitis predominantly occurs in patients with chronic constipation and specific risk factors:
- Elderly or bedbound patients with limited mobility 1, 3
- Chronic opioid users (13.8% of cases) who develop medication-induced constipation 3, 4
- Patients with mental impairment or intellectual disability who may not recognize or communicate symptoms 4
- Nursing home residents with multiple comorbidities 4
- Patients with chronic constipation (present in 75.9% of cases) 3
Importantly, while most common in elderly populations, stercoral colitis does occur in younger patients with comorbidities that increase risk for fecal impaction 1.
Clinical Pitfalls
The diagnosis is challenging because:
- Only 75.9% of patients present with abdominal pain, so its absence does not exclude the disease 3
- Clinical presentation is often nonspecific and varied, requiring high clinical suspicion 1, 2
- No established diagnostic criteria exist to date, making recognition difficult in the emergency setting 1
The condition carries significant risk, with complications including bowel ulceration, ischemia, perforation, peritonitis, and sepsis, and an overall in-hospital/30-day mortality of 22.4% 3, 4.