High risk and low incidence diseases: Stercoral colitis

Stercoral colitis is a rare but serious diagnosis which is associated with a high rate of morbidity.

This review highlights the pearls and pitfalls of stercoral colitis, including presentation, diagnosis, and emergency department (ED) management based on the available evidence.

Stercoral colitis is an uncommon inflammatory condition of the distal large bowel and rectum resulting from accumulation of impacted stool and is associated with several complications including bowel ulceration, ischemia, perforation, peritonitis, and sepsis. Though most commonly present with abdominal pain and constipation, many patients present without typical symptoms requiring emergency clinicians to maintain high clinical suspicion, especially in patients at high risk for developing severe constipation. The diagnosis can be secured with cross-sectional radiography, including computed tomography of the abdomen and pelvis. ED management includes fluid resuscitation, initiation of a multimodal bowel regimen, and if indicated, initiation of parenteral antibiotics and consultation with a surgical specialist. Admission to the hospital should be considered for all patients with stercoral colitis.

An understanding of stercoral colitis can assist emergency clinicians in diagnosing and appropriately managing this high risk disease.