Fecal Impaction and Stercoral Ulceration

Published on 18/07/2015 by admin

Filed under Radiology

Last modified 22/04/2025

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 Pressure necrosis of bowel lumen (rectum or sigmoid) by fecal mass

IMAGING

• CECT to evaluate for perirectal and intraperitoneal complications

image Fecaloma: Entirely intraluminal mass
image Calcification or high-density matter in or around fecal mass
image Laminated, radiopaque mass of feces
image Focal thickening of bowel wall and pericolonic fat stranding (suggests stercoral colitis)
image Pneumatosis, free air (confirms perforation)

TOP DIFFERENTIAL DIAGNOSES

• Colon carcinoma

image Thickens wall of colon, narrows lumen
• Villous adenoma, colon

image Bulky but soft intraluminal and mural mass

PATHOLOGY

• Stercoral colitis: Focal inflammatory colitis due to ↑ pressure on bowel wall by fecal mass
• Stercoral ulcer: Pressure necrosis of bowel mucosa on antimesenteric aspect of bowel

image Perforation: Associated with 35% mortality

CLINICAL ISSUES

• Can be life-threatening and is underdiagnosed
• Usually seen in elderly, debilitated patients

image Or patients on anticholinergic or narcotic medications
• Requires urgent catharsis, enema, manual disimpaction
• Emergency surgery for perforation
image
(Left) CT in an 85-year-old woman with chronic constipation and acute abdominal pain shows free intraperitoneal air image.

image
(Right) Sagittal reformatted CT section in the same case shows massive fecal distention of the rectosigmoid colon with disruption image of the anterior wall of the sigmoid colon.
image
(Left) Axial CECT in an 80-year-old woman presenting with chronic constipation and acute abdominal pain shows free intraperitoneal gas image and massive distention of the rectum and left colon with gas and impacted feces image.

image
(Right) Axial CECT in the same patient shows the rectum massively distended with high density feces image. Infiltration of the perirectal fat image suggests stercoral ulceration, confirmed at surgery. The rectal perforation by stercoral colitis was fatal in this case.