Stercoral perforation is defined as a bowel perforation due to pressure necrosis from a fecal mass (fecaloma) 1. It is an uncommon, but life-threatening, complication of unresolved fecal impaction and can be a cause of acute abdomen secondary to fecal peritonitis.
It may represent 3.2% of all colonic perforations and 2.2% of randomly-selected autopsy examinations 2. It generally occurs in older individuals 8.
Conditions causing chronic constipation:
- opioid/narcotic use 3
- NSAID use: possible 7,8
The postulated pathogenesis is from a rise in intraluminal pressure which becomes greater than the capillary perfusion pressure within the bowel. This then results in focal ischemia, necrosis, ulceration, and ultimately perforation 1,2.
It typically involves the rectosigmoid colon on the antimesenteric side in ~90% of cases 7.
A universal component in a stercoral perforation is the formation of a fecaloma which is a localized hard, inspissated, or calcified fecal mass, usually of a diameter equal to or greater than the colonic lumen (due to the lowest blood supply and narrowest diameter).
There is evidence of extraluminal gas +/- extruding fecal content. The site of perforation usually involves the antimesenteric border of the colon.
Treatment and prognosis
They can be life-threatening with mortality rates ranging between 30-55% 8.
Stercoral perforations are almost always free and open, although to some extent plugged by a fecaloma, hence unlikely to resolve spontaneously with conservative management.
- 1. Kumar P, Pearce O, Higginson A. Imaging manifestations of faecal impaction and stercoral perforation. Clin Radiol. 2011;66 (1): 83-8. doi:10.1016/j.crad.2010.08.002 - Pubmed citation
- 2. Hsiao TF, Chou YH. Stercoral perforation of colon: a rare but important mimicker of acute appendicitis. Am J Emerg Med. 2010;28 (1): 112.e1-2. doi:10.1016/j.ajem.2009.02.024 - Pubmed citation
- 3. Tessier DJ, Harris E, Collins J et-al. Stercoral perforation of the colon in a heroin addict. Int J Colorectal Dis. 2002;17 (6): 435-7. doi:10.1007/s00384-002-0417-4 - Pubmed citation
- 4. Yano T, Wakabayashi H, Yachida S et-al. A stercoral perforation of the colon with an obvious faecal mass diagnosed by computed tomography. ANZ J Surg. 2008;78 (3): 214-5. doi:10.1111/j.1445-2197.2007.04411.x - Pubmed citation
- 5. Serpell JW, Nicholls RJ. Stercoral perforation of the colon. Br J Surg. 1990;77 (12): 1325-9. - Pubmed citation
- 6. Guyton DP, Evans D, Schreiber H. Stercoral perforation of the colon. Concepts of operative management. Am Surg. 1985;51 (9): 520-2. - Pubmed citation
- 7. Patel VG, Kalakuntla V, Fortson JK et-al. Stercoral perforation of the sigmoid colon: report of a rare case and its possible association with nonsteroidal anti-inflammatory drugs. Am Surg. 2002;68 (1): 62-4. - Pubmed citation
- 8. Wu CH, Huang CC, Wang LJ et-al. Value of CT in the discrimination of fatal from non-fatal stercoral colitis. Korean J Radiol. 13 (3): 283-9. doi:10.3348/kjr.2012.13.3.283 - Free text at pubmed - Pubmed citation