Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes

Fecal impaction and stercoral colitis are common, yet little research has been performed on the associated mortality risk. We performed a retrospective cohort study of 970 hospital encounters representing 885 unique patients in which fecal impaction or stercoral colitis was identified in CT reports. Among the 535 patients with fecal impaction, 13.3% died or were discharged to hospice, compared to 13.1% among the 428 patients with nonperforated stercoral colitis (p = 0.93). Of the seven patients with perforation, five died or were discharged to hospice. The risk of death or discharge to hospice for patients with fecal impaction or nonperforated stercoral colitis aged 18-49 was 2.9% and rose approximately 4% each decade thereafter to 21.9% for patients 90 and older (p< 0.001). Patients with a body mass index of 25-30 had an 8.1% risk of death or discharge to hospice, compared to 23.4% for those with a BMI < 18.5 (p< 0.001). Patients with at least one ICD-10 code for dementia, paralysis/neuromuscular disease, or malnutrition/failure to thrive had a risk of death or discharge to hospice of 21.6%, compared to 1.9% among patients with none of these risk factors (p< 0.001). ICD-10 codes for sepsis were associated with 90.0% of the deaths and 44.3% of the discharges to hospice. Patients diagnosed in less than three hours had a risk of death or discharge to hospice of 8.0%, compared to a risk of 20.1% for those diagnosed in ≥ 12 hours (p< 0.001).