Stercoral colitis - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:59:36Z

Prepared the page for translation

← Older revision		Revision as of 23:59, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Diameters of the large intestine.png\|thumb\|Normal inner diameters of colon sections.]]		[[File:Diameters of the large intestine.png\|thumb\|Normal inner diameters of colon sections.]]
	*Inflammatory [[colitis]] related to increased intraluminal pressure from [[fecal impaction\|impacted fecal material]] in the colon		*Inflammatory [[Special:MyLanguage/colitis\|colitis]] related to increased intraluminal pressure from [[Special:MyLanguage/fecal impaction\|impacted fecal material]] in the colon
	**Pressure from fecaloma or colonic distention may cause ulceration/necrosis and ultimately perforation		**Pressure from fecaloma or colonic distention may cause ulceration/necrosis and ultimately perforation
	*Rare condition, but with high mortality rate (32-59%) when complicated by perforation<ref>Morano C, Sharman T. Stercoral Colitis. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560608/</ref>		*Rare condition, but with high mortality rate (32-59%) when complicated by perforation<ref>Morano C, Sharman T. Stercoral Colitis. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560608/</ref>
	*Primarily in elderly, nursing home, or young patients with neurological impairment, chronic opioid use		*Primarily in elderly, nursing home, or young patients with neurological impairment, chronic opioid use


	==Clinical Features==		==Clinical Features==
	*History of chronic [[constipation]] and/or [[fecal impaction]]
	*May be asymptomatic or have only mild [[abdominal pain]] at initial stages		*History of chronic [[Special:MyLanguage/constipation\|constipation]] and/or [[Special:MyLanguage/fecal impaction\|fecal impaction]]
			*May be asymptomatic or have only mild [[Special:MyLanguage/abdominal pain\|abdominal pain]] at initial stages
	**Maintain a high index of suspicion; a recent review shows lack of abdominal pain in as much as 62% of cases<ref>Keim AA, Campbell RL, Mullan AF, McElhinny ML, Monas J, Finch AS, Mathis KL, Lindor RA. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Ann Emerg Med. 2023 Jul;82(1):37-46. doi: 10.1016/j.annemergmed.2023.02.003. Epub 2023 Mar 23. PMID: 36966044.</ref>		**Maintain a high index of suspicion; a recent review shows lack of abdominal pain in as much as 62% of cases<ref>Keim AA, Campbell RL, Mullan AF, McElhinny ML, Monas J, Finch AS, Mathis KL, Lindor RA. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Ann Emerg Med. 2023 Jul;82(1):37-46. doi: 10.1016/j.annemergmed.2023.02.003. Epub 2023 Mar 23. PMID: 36966044.</ref>
	*Abdominal pain/tenderness, distension, [[vomiting]] are most common symptoms <ref> Tsai TC, Chao CM. Stercoral colitis. Resuscitation & Intensive Care Med 2017;4:231-232 http://www.tsccm.org.tw/Magazine/Folder/a02_4/N20183712037_14-%BCv%B9%B3-10502-%BD%B2%A9v%A7%D3-231-232.pdf </ref>		*Abdominal pain/tenderness, distension, [[Special:MyLanguage/vomiting\|vomiting]] are most common symptoms <ref> Tsai TC, Chao CM. Stercoral colitis. Resuscitation & Intensive Care Med 2017;4:231-232 http://www.tsccm.org.tw/Magazine/Folder/a02_4/N20183712037_14-%BCv%B9%B3-10502-%BD%B2%A9v%A7%D3-231-232.pdf </ref>
	*Rectal bleeding		*Rectal bleeding
	*Symptoms and signs of peritonitis or shock		*Symptoms and signs of peritonitis or shock


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Constipation DDX}}		{{Constipation DDX}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:179e455f29abdcd110a7e67428587e big gallery.jpg\|thumb\|Abdominal CT showing stercoral colitis with preformation (free air shown by arrows).]]		[[File:179e455f29abdcd110a7e67428587e big gallery.jpg\|thumb\|Abdominal CT showing stercoral colitis with preformation (free air shown by arrows).]]

	===Work up===		===Work up===

	*Digital rectal exam		*Digital rectal exam
	*Abdominal panel		*Abdominal panel
	**CBC		**CBC
	**Chemistry ([[hypokalemia]] or [[hypercalcemia]])		**Chemistry ([[Special:MyLanguage/hypokalemia\|hypokalemia]] or [[Special:MyLanguage/hypercalcemia\|hypercalcemia]])
	**LFTs + lipase		**LFTs + lipase
	**Consider coagulation studies (PT, PTT, INR), as a marker of liver function		**Consider coagulation studies (PT, PTT, INR), as a marker of liver function
	*[[Lactate]]		*[[Special:MyLanguage/Lactate\|Lactate]]
	*Consider preoperative labs including type & screen		*Consider preoperative labs including type & screen
	*Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]]		*Consider [[Special:MyLanguage/TSH\|TSH]] if concern for [[Special:MyLanguage/hypothyroid\|hypothyroid]] related [[Special:MyLanguage/constipation\|constipation]]
	*CT abdomen/pelvis with IV contrast		*CT abdomen/pelvis with IV contrast
	**CT findings with focal thickening of colonic wall, stranding of pericolonic fat in segment showing fecal impaction, and presence of extraluminal bubbles of gas or abscess <ref> Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193. </ref>		**CT findings with focal thickening of colonic wall, stranding of pericolonic fat in segment showing fecal impaction, and presence of extraluminal bubbles of gas or abscess <ref> Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193. </ref>
	**Fecolomas may be visualized as radiopaque masses		**Fecolomas may be visualized as radiopaque masses


	===Diagnosis===		===Diagnosis===

	*Diagnosis is typically made on CT		*Diagnosis is typically made on CT


	==Management==		==Management==

	*Fluid resuscitation		*Fluid resuscitation
	*Broad spectrum [[antibiotics]] covering intra-abdominal flora (e.g., [[ceftriaxone]] + [[metronidazole]])		*Broad spectrum [[Special:MyLanguage/antibiotics\|antibiotics]] covering intra-abdominal flora (e.g., [[Special:MyLanguage/ceftriaxone\|ceftriaxone]] + [[Special:MyLanguage/metronidazole\|metronidazole]])
	*Surgical consult, NPO		*Surgical consult, NPO
	**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia		**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia


	==Disposition==		==Disposition==

	*Admit		*Admit


	==See Also==		==See Also==
	*[[Fecal impaction]]
			*[[Special:MyLanguage/Fecal impaction\|Fecal impaction]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>
	[[Category:GI]] [[Category:Surgery]]		[[Category:GI]] [[Category:Surgery]]
			</translate>

Rossdonaldson1: /* Management */

2024-02-14T21:35:10Z

Management

← Older revision		Revision as of 21:35, 14 February 2024
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	==Management==		==Management==
	*Fluid resuscitation		*Fluid resuscitation
	*Broad spectrum [[antibiotics]]		*Broad spectrum [[antibiotics]] covering intra-abdominal flora (e.g., [[ceftriaxone]] + [[metronidazole]])
	*Surgical consult, NPO		*Surgical consult, NPO
	**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia		**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia

Rossdonaldson1: Undo revision 372711 by Rossdonaldson1 (talk)

2024-02-14T21:08:55Z

Undo revision 372711 by Rossdonaldson1 (talk)

← Older revision		Revision as of 21:08, 14 February 2024
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	==Management==		==Management==
	*Fluid resuscitation		*Fluid resuscitation
	*Broad spectrum [[antibiotics]] ~~for intra-abdominal flora (e.g., [[ceftriaxone]] + [[metronidazole]])~~		*Broad spectrum [[antibiotics]]
	*Surgical consult, NPO		*Surgical consult, NPO
	**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia		**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia

Rossdonaldson1: /* Management */

2024-02-14T21:07:44Z

Management

← Older revision		Revision as of 21:07, 14 February 2024
Line 38:		Line 38:
	==Management==		==Management==
	*Fluid resuscitation		*Fluid resuscitation
	*Broad spectrum [[antibiotics]]		*Broad spectrum [[antibiotics]] for intra-abdominal flora (e.g., [[ceftriaxone]] + [[metronidazole]])
	*Surgical consult, NPO		*Surgical consult, NPO
	**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia		**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia

Rossdonaldson1: /* Management */

2024-02-14T21:06:47Z

Management

← Older revision		Revision as of 21:06, 14 February 2024
Line 37:		Line 37:

	==Management==		==Management==
			*Fluid resuscitation
			*Broad spectrum [[antibiotics]]
	*Surgical consult, NPO		*Surgical consult, NPO
	**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia		**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia
	*Fluid resuscitation
	*Consider broad spectrum [[antibiotics]]

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2024-02-14T21:06:21Z

Management

← Older revision		Revision as of 21:06, 14 February 2024
Line 38:		Line 38:
	==Management==		==Management==
	*Surgical consult, NPO		*Surgical consult, NPO
	**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas) if no evidence of bowel perforation or ischemia		**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia
	*Fluid resuscitation		*Fluid resuscitation
	*Consider broad spectrum [[antibiotics]]		*Consider broad spectrum [[antibiotics]]
	*Initiate bowel regimen

	==Disposition==		==Disposition==

Rossdonaldson1: /* Work up */

2024-02-14T18:10:36Z

Work up

← Older revision		Revision as of 18:10, 14 February 2024
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	**Chemistry ([[hypokalemia]] or [[hypercalcemia]])		**Chemistry ([[hypokalemia]] or [[hypercalcemia]])
	**LFTs + lipase		**LFTs + lipase
			**Consider coagulation studies (PT, PTT, INR), as a marker of liver function
	*[[Lactate]]		*[[Lactate]]
	*Consider preoperative labs including type & screen ~~or coags~~		*Consider preoperative labs including type & screen
	*Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]]		*Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]]
	*CT abdomen/pelvis with IV contrast		*CT abdomen/pelvis with IV contrast

Rossdonaldson1: /* Evaluation */

2024-02-14T18:09:33Z

Evaluation

← Older revision		Revision as of 18:09, 14 February 2024
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	==Evaluation==		==Evaluation==
	[[File:179e455f29abdcd110a7e67428587e big gallery.jpg\|thumb\|Abdominal CT showing stercoral colitis with preformation (free air shown by arrows).]]		[[File:179e455f29abdcd110a7e67428587e big gallery.jpg\|thumb\|Abdominal CT showing stercoral colitis with preformation (free air shown by arrows).]]
	*CBC		===Work up===
	*~~CMP~~		*Digital rectal exam
	*~~Lactate~~		*Abdominal panel
	*~~Inflammatory markers~~		**CBC
			**Chemistry ([[hypokalemia]] or [[hypercalcemia]])
			**LFTs + lipase
			*[[Lactate]]
	*Consider preoperative labs including type & screen or coags		*Consider preoperative labs including type & screen or coags
	*CT findings with focal thickening of colonic wall, stranding of pericolonic fat in segment showing fecal impaction, and presence of extraluminal bubbles of gas or abscess <ref> Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193. </ref>		*Consider [[TSH]] if concern for [[hypothyroid]] related [[constipation]]
	**Fecolomas may be visualized as radiopaque masses		*CT abdomen/pelvis with IV contrast
			**CT findings with focal thickening of colonic wall, stranding of pericolonic fat in segment showing fecal impaction, and presence of extraluminal bubbles of gas or abscess <ref> Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193. </ref>
			**Fecolomas may be visualized as radiopaque masses

			===Diagnosis===
			*Diagnosis is typically made on CT

	==Management==		==Management==

Rossdonaldson1: /* Management */

2024-02-14T17:50:24Z

Management

← Older revision		Revision as of 17:50, 14 February 2024
Line 31:		Line 31:
	**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas) if no evidence of bowel perforation or ischemia		**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas) if no evidence of bowel perforation or ischemia
	*Fluid resuscitation		*Fluid resuscitation
	*Consider broad spectrum ~~ABX~~		*Consider broad spectrum [[antibiotics]]
	*Initiate bowel regimen		*Initiate bowel regimen

Patricklin at 16:30, 2 February 2024

2024-02-02T16:30:37Z

← Older revision		Revision as of 16:30, 2 February 2024
Line 2:		Line 2:
	[[File:Diameters of the large intestine.png\|thumb\|Normal inner diameters of colon sections.]]		[[File:Diameters of the large intestine.png\|thumb\|Normal inner diameters of colon sections.]]
	*Inflammatory [[colitis]] related to increased intraluminal pressure from [[fecal impaction\|impacted fecal material]] in the colon		*Inflammatory [[colitis]] related to increased intraluminal pressure from [[fecal impaction\|impacted fecal material]] in the colon
	**Pressure may cause ulceration and ultimately perforation		**Pressure from fecaloma or colonic distention may cause ulceration/necrosis and ultimately perforation
	*Rare condition		*Rare condition, but with high mortality rate (32-59%) when complicated by perforation<ref>Morano C, Sharman T. Stercoral Colitis. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560608/</ref>
	*Primarily in elderly, nursing home or young patients with neurological impairment, chronic opioid use		*Primarily in elderly, nursing home, or young patients with neurological impairment, chronic opioid use

	==Clinical Features==		==Clinical Features==
	*History of chronic [[constipation]]		*History of chronic [[constipation]] and/or [[fecal impaction]]
	*May be asymptomatic or have only mild [[abdominal pain]] at initial stages		*May be asymptomatic or have only mild [[abdominal pain]] at initial stages
			**Maintain a high index of suspicion; a recent review shows lack of abdominal pain in as much as 62% of cases<ref>Keim AA, Campbell RL, Mullan AF, McElhinny ML, Monas J, Finch AS, Mathis KL, Lindor RA. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Ann Emerg Med. 2023 Jul;82(1):37-46. doi: 10.1016/j.annemergmed.2023.02.003. Epub 2023 Mar 23. PMID: 36966044.</ref>
	*Abdominal pain/tenderness, distension, [[vomiting]] are most common symptoms <ref> Tsai TC, Chao CM. Stercoral colitis. Resuscitation & Intensive Care Med 2017;4:231-232 http://www.tsccm.org.tw/Magazine/Folder/a02_4/N20183712037_14-%BCv%B9%B3-10502-%BD%B2%A9v%A7%D3-231-232.pdf </ref>		*Abdominal pain/tenderness, distension, [[vomiting]] are most common symptoms <ref> Tsai TC, Chao CM. Stercoral colitis. Resuscitation & Intensive Care Med 2017;4:231-232 http://www.tsccm.org.tw/Magazine/Folder/a02_4/N20183712037_14-%BCv%B9%B3-10502-%BD%B2%A9v%A7%D3-231-232.pdf </ref>
	*Mortality rate between 32-59% if associated with perforation<ref>Morano C, Sharman T. Stercoral Colitis. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560608/</ref>		*Rectal bleeding
			*Symptoms and signs of peritonitis or shock

	==Differential Diagnosis==		==Differential Diagnosis==
Line 17:		Line 19:
	==Evaluation==		==Evaluation==
	[[File:179e455f29abdcd110a7e67428587e big gallery.jpg\|thumb\|Abdominal CT showing stercoral colitis with preformation (free air shown by arrows).]]		[[File:179e455f29abdcd110a7e67428587e big gallery.jpg\|thumb\|Abdominal CT showing stercoral colitis with preformation (free air shown by arrows).]]
			*CBC
			*CMP
			*Lactate
			*Inflammatory markers
			*Consider preoperative labs including type & screen or coags
	*CT findings with focal thickening of colonic wall, stranding of pericolonic fat in segment showing fecal impaction, and presence of extraluminal bubbles of gas or abscess <ref> Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193. </ref>		*CT findings with focal thickening of colonic wall, stranding of pericolonic fat in segment showing fecal impaction, and presence of extraluminal bubbles of gas or abscess <ref> Heffernan C. et al. Stercoral Colitis Leading to Fatal Peritonitis: CT findings. American Journal of Roentgenology, 2005. 184(4); 1189-1193. </ref>
			**Fecolomas may be visualized as radiopaque masses

	==Management==		==Management==
	*Surgical consult		*Surgical consult, NPO
	**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas), if no evidence of bowel perforation or ischemia		**May ultimately be treated nonsurgically (e.g. manual disimpaction, enemas) if no evidence of bowel perforation or ischemia
			*Fluid resuscitation
			*Consider broad spectrum ABX
			*Initiate bowel regimen

	==Disposition==		==Disposition==
Line 30:		Line 41:

	==External Links==		==External Links==


	==References==		==References==
	<references/>		<references/>
	[[Category:GI]] [[Category:Surgery]]		[[Category:GI]] [[Category:Surgery]]