Presentation
Diffuse abdominal pain of 1-day duration, associated with nausea and an episode of vomiting. No change in bowel habits.
Patient Data
Standing chest x-ray reveals air under the diaphragm and Rigler's sign due to pneumoperitoneum.
No radiological signs of bowel obstruction.
There is a small focal collection of faeces in a large outpouching of the sigmoid colon without signs of obstruction but with signs of local and disseminated perforation by way of free intraperitoneal gas.
This process is associated with regional misty mesentery and a minimal amount of free fluid.
There is a left renal cortical cyst.
A nasogastric (NG) tube is noted.
Case Discussion
The patient had a history of H. pylori gastritis three weeks before presentation. She sought medical advice as an outpatient and was treated as a flare attack. Since no improvement had been achieved, she presented to the emergency room and managed accordingly.
Operative note: the sigmoid colon was explored and a mass and perforation on the antimesenteric side was visualised. No active soiling was identified. The mass protruded outside the lumen - resembling a wide-neck true diverticulum. The decision was made to perform a segmental resection with primary anastomosis.
Histopathology results: perforation with serositis and no evidence of malignancy.
Stercoral perforation is a rare but serious condition where hardened stool (faecaloma) causes a tear or perforation in the intestinal wall, typically in the colon, leading to peritonitis and requiring urgent surgical intervention.
Contributed by: Mohammed Ibrahim Abu Kamesh