Stercoral colitis due to massive fecal impaction: a case report and literature review

Stercoral colitis is a rare inflammatory condition involving the large bowel wall secondary to fecal impaction. Stercoral colitis has a clinical course ranging from non-complicated fecaloid impaction to colonic perforation. This case report aims to give a brief review of this condition and discuss its imaging findings.

We herein report a case 74-year-old female who presented with abdominal pain, abdominal distension, and the absence of gas-feces discharge for a few days. The patient had a one-year history of chronic constipation and recent femoral neck fracture surgery. Physical examination shows abdominal distension with slight tenderness. Abdominal radiographs demonstrated bowel distention and fecal material in the colorectal regions. Computed tomography (CT) images demonstrated abundant fecal material with massive dilatation in the rectosigmoid colon, focal mural thickening, subtle pericolic fat stranding, and minimal free fluid in the abdominal and pelvic cavities. Based on these findings, the diagnosis of stercoral colitis was made. The patient was treated conservatively and eventually discharged with a good health condition.

Stercoral colitis seems to be more common in elderly patients with comorbid diseases. Chronic constipation causing fecal impaction is a major risk factor. CT scan is the most helpful imaging modality for the diagnosis of stercoral colitis. CT findings that should prompt the radiologist to consider this diagnosis include colonic dilatation containing impacted feces, mural thickening, and pericolic fat stranding. If the fecal impaction is not promptly relieved, life-threatening complications such as colonic perforation can occur.