From the Research
A perirectal exam should be avoided in patients with suspected stercoral colitis due to the risk of perforation. Stercoral colitis is a serious inflammatory condition caused by pressure necrosis from impacted feces against the colonic wall, most commonly in the rectosigmoid region. The affected bowel wall is often thin and friable, making it susceptible to perforation during digital examination. Instead, imaging studies such as CT scan should be the preferred diagnostic approach as they can safely identify fecal impaction, colonic wall thickening, and potential complications without physical manipulation of the affected area.
Key Considerations
- If a patient presents with symptoms suggestive of stercoral colitis (abdominal pain, constipation, distension), the clinician should proceed directly to imaging and avoid digital rectal examination.
- Treatment typically involves careful disimpaction, bowel rest, IV fluids, and possibly surgical intervention for complications, but the initial assessment should prioritize non-invasive methods to prevent iatrogenic perforation.
- The most recent study 1 highlights the importance of timely recognition and appropriate treatment to reduce morbidity and mortality associated with stercoral colitis.
Diagnostic Approach
- CT scans are crucial for diagnosis, revealing key findings such as fecaloma, colonic dilatation, and fat stranding 1, 2.
- The presence of a large fecaloma with distention of the affected colon and wall thickening and pericolonic fat stranding should alert radiologists and surgeons to the presence of this potentially fatal condition 3.
Management
- Treatment depends on the severity of illness, ranging from manual disimpaction and other conservative measures for most cases, to surgical intervention for complicated cases, such as stercoral perforation 1, 4.
- Patients with stercoral colitis often present in a nonspecific manner, and short-term mortality is substantial, emphasizing the need for prompt and appropriate management 4.