Chronic Constipation With a Rare Complication of Ischemic Stercoral Perforation of the Rectum: A Case Report

Stercoral perforation is a rare but life-threatening complication of chronic constipation, resulting from pressure necrosis of the colonic wall by impacted fecal material. We report the case of a previously healthy 48-year-old woman who presented with acute anal pain and constipation. Despite initial conservative management, her symptoms rapidly worsened. Cross-sectional imaging revealed a large fecaloma in the sigmoid colon with signs of colonic ischemia and perforation. Emergency laparotomy confirmed a substantial anterior rectal wall perforation, and a Hartmann's procedure was performed. Histopathological examination demonstrated transmural necrosis and ulceration consistent with stercoral disease. The patient had an uneventful postoperative course, with resolution of sepsis and stabilization of hematologic abnormalities. This case highlights the importance of early recognition and imaging in patients with severe constipation and abdominal symptoms. Stercoral perforation, though rare, must be considered in the differential diagnosis of acute abdomen, and timely surgical intervention remains essential to prevent catastrophic outcomes.