Constipation-Associated Stercoral Colitis

A 9-year-old white girl with a history of constipation presented to the emergency department with a few weeks of intermittent stool incontinence without any reported changes in diet or difficulty tolerating food or fluids by mouth. On the day of presentation, she developed nausea and nonbloody, nonbilious emesis, as well as multiple, loose, nonbloody stools, after becoming acutely ill during lunch at school. There was no reported fever or suspicious food intake. On examination, she was noted to be afebrile, hypotensive, and tachycardic with abdominal tenderness. Her blood work was notable for a marked leukocytosis of 66,000 and a subsequent computed tomography scan of her abdomen was performed. The imaging test identified a large fecaloma with surrounding colonic inflammation concerning for stercoral colitis. The child underwent urgent manual disimpaction and was hospitalized for supportive care with subsequent recovery and return to her normal state of health. Follow-up testing during her hospital stay did not reveal any other infectious or physiologic cause for her constipation and colitis.