Stercoral perforation

Case contributed by Dr Ian Bickle

Presentation

Acute abdominal pain. Peritonism. No abdominal distension. No past history.

Patient Data

Age: 64
Gender: Female
Modality: CT

Thickened (odematous) rectosigmoid, with a large volume of adjacent extra-luminal free air.

Adjacent to the recto-sigmoid is a mass with an appearance similar to faeces, lying outside of the colon.

Free air in the upper abdomen.

Case Discussion

In stercoral perforation a faecaloma if formed (a localised hard, inspissated, or calcified faecal mass) usually of a diameter equal to or greater than the colonic lumen.  This is thought to cause pressure necrosis on the colonic wall, resulting in perforation.   This then causes both local and sometimes distant extra-luminal air and an adjacent extruded faecal content.  The recto-sigmoid is by far the commonest location.

The absence of another cause for perforation, such as a diverticulum, tumour of inflammed colonic wall is also often a clue.

Laparotomy identified a large faeculoma and a stercoral perforation.

PlayAdd to Share

Case Information

rID: 43070
Case created: 22nd Feb 2016
Last edited: 22nd Feb 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.