Stercoral Colitis: An Unexpected Presentation in a Young Adolescent

Stercoral colitis is an uncommon inflammatory condition primarily affecting individuals with chronic constipation, immobilization, and advanced age, occasionally manifesting in pediatric patients. It arises from the accumulation of impacted fecal matter, leading to colonic distension and subsequent fecaloma formation, culminating in pressure necrosis and perforation. Mortality rates can exceed 60% in vulnerable populations due to complications such as colonic perforation and ischemia. Presented is the case of a 14-year-old female with stercoral colitis, initially presenting with diarrhea, abdominal pain, and metabolic acidosis. Despite improvement followed by a sudden deterioration, diagnostic challenges persisted, highlighting the complexity of diagnosing this condition, especially in pediatric cases. Key diagnostic criteria include vague abdominal symptoms, leukocytosis, and elevated inflammatory markers, alongside potential metabolic derangements. Imaging modalities, such as abdominal CT scans, aid in diagnosis, delineating features like colonic distension and wall thickening. Treatment strategies encompass aggressive bowel disimpaction, with endoscopic or surgical interventions reserved for refractory cases or perforations. Recognition of stercoral colitis is crucial for timely intervention, given its significant morbidity and mortality. Although typically associated with elderly or bedbound patients, the condition can also affect younger individuals, emphasizing the importance of considering it in the differential diagnosis, particularly in cases of chronic constipation. Integration of diagnostic imaging techniques facilitates accurate diagnosis, guiding appropriate therapeutic interventions and potentially mitigating adverse outcomes.