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Pelvic Rectal Stercoral Perforation Resulting in Diffuse Pneumatosis
Anupam K Gupta1, Oscar A Vazquez2, Miguel Lopez-Viego2,3
1Minimally Invasive Surgery, University of Miami Hospital, Miami, USA.
Cureus
|August 14, 2020
Summary
An elderly woman on corticosteroids developed rectal perforation and widespread gas in her tissues due to a fecaloma. Despite surgery, she experienced multiorgan failure and expired.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Critical Care Medicine
Background:
- Oral corticosteroid use is common for chronic autoimmune conditions.
- Corticosteroids can predispose patients to gastrointestinal complications.
- Fecal impaction is a known risk in the elderly and those with motility disorders.
Observation:
- An 83-year-old woman presented with abdominal pain and constipation.
- Imaging revealed a large fecaloma with extensive extraluminal gas (pneumatosis).
- Pneumatosis involved the retroperitoneum, subcutaneous tissues, and mediastinum.
Findings:
- Exploratory laparotomy confirmed rectal perforation below the peritoneal reflection.
- The perforation extended into the retroperitoneum.
- An end-colostomy with Hartmann's procedure was performed.
Implications:
- Rectal perforation secondary to fecaloma is a rare but life-threatening emergency.
- Widespread pneumatosis indicates severe bowel compromise and potential sepsis.
- Prompt surgical intervention is critical, but outcomes can be poor in severe cases, especially with pre-existing comorbidities and corticosteroid use.
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