From the Research
Stercoral colitis treatment requires prompt medical intervention to prevent serious complications like perforation and sepsis, with the most recent and highest quality study 1 guiding the approach. Initial treatment focuses on relieving the fecal impaction through manual disimpaction, enemas, or water-soluble contrast enemas. Oral laxatives like polyethylene glycol or lactulose may be used for less severe cases. Intravenous fluids are essential to correct dehydration and electrolyte imbalances. Broad-spectrum antibiotics (such as piperacillin-tazobactam 3.375g IV every 6 hours or ceftriaxone 1-2g IV daily plus metronidazole 500mg IV every 8 hours) should be administered if infection is suspected or to prevent infection after disimpaction, as supported by previous studies 2, 3, 4. Pain management with appropriate analgesics is important. In severe cases with perforation, immediate surgical intervention is necessary, which may include colonic resection with colostomy. After resolving the acute episode, prevention strategies are crucial, including increased dietary fiber (25-30g daily), adequate hydration (2-3 liters daily), regular physical activity, and establishing a consistent bowel routine. Patients with recurrent episodes may benefit from scheduled osmotic laxatives or stool softeners. This comprehensive approach addresses the immediate fecal impaction while preventing recurrence by modifying contributing factors.
Key Considerations
- Prompt diagnosis and treatment are essential to prevent complications and improve outcomes, as highlighted in the study by 1.
- Imaging, especially CT, plays a vital role in the diagnosis of stercoral colitis, demonstrating hallmark features such as fecal impaction and a large colorectal stool burden.
- The overlap of findings between stercoral colitis and other colonic diseases can sometimes make diagnosis challenging, but identification of fecal impaction and associated inflammatory changes helps in distinguishing stercoral colitis from other pathologic conditions.
- Prevention strategies, including increased dietary fiber, adequate hydration, regular physical activity, and establishing a consistent bowel routine, are crucial in preventing recurrence and modifying contributing factors.
Treatment Approach
- Initial treatment: manual disimpaction, enemas, or water-soluble contrast enemas
- Oral laxatives: polyethylene glycol or lactulose for less severe cases
- Intravenous fluids: essential to correct dehydration and electrolyte imbalances
- Broad-spectrum antibiotics: administer if infection is suspected or to prevent infection after disimpaction
- Pain management: appropriate analgesics
- Surgical intervention: necessary in severe cases with perforation, which may include colonic resection with colostomy.