Stercoral Perforation and Colitis Management
Summary
Stercoral colitis arises from prolonged faecal impaction, in which hardened stool exerts sustained pressure on the colonic wall, leading to mucosal ulceration, transmural necrosis and, in severe cases, perforation. Although uncommon, stercoral perforation carries a high mortality rate, particularly among elderly, immobilised or opioid-dependent patients. Clinical presentation is often nonspecific, with diffuse abdominal pain, distension and systemic features such as fever or sepsis. Cross-sectional imaging, especially contrast-enhanced CT, is pivotal for early detection of faecalomas, colonic dilation, fat stranding and pneumoperitoneum. Management spans a spectrum from conservative bowel regimens—manual disimpaction, enemas and osmotic laxatives—to urgent surgical intervention. Surgical options include segmental resection with primary anastomosis, Hartmann’s procedure or subtotal colectomy, guided by the extent of necrosis and patient comorbidity. Multidisciplinary collaboration among surgeons, gastroenterologists and radiologists is essential for optimising outcomes. As populations age and polypharmacy rises, recognition of stercoral pathology and standardised diagnostic and therapeutic algorithms are of growing global importance.
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Stercoral Perforation and Colitis Management publication trend
The graph below shows the total number of articles in stercoral perforation and colitis management across all publications each year (not limited to Nature Index journals).
Technical terms
Stercoral colitis: Inflammation of the colon wall caused by pressure necrosis from impacted faeces.
Faecal impaction: Accumulation of hard stool that cannot be evacuated by normal bowel movements.
Faecaloma: A hardened mass of faeces resembling a tumour, often seen on imaging.
Perforation: Full-thickness breach of the intestinal wall allowing luminal contents to leak into the peritoneal cavity.
Ischaemic colitis: Inflammation and injury of the colon due to insufficient blood supply.
Hartmann’s procedure: Surgical resection of a diseased colon segment with end colostomy formation and rectal stump closure.
Pneumoperitoneum: Presence of free gas within the peritoneal cavity, usually indicative of visceral perforation.
References
- Stercoral colitis in the emergency department: a review of the literature. International Journal of Emergency Medicine (2024).
- Stercoral Perforation in the Setting of Chronic Antipsychotic Use: A Case Report. Cureus (2023).
- Non-perforated Stercoral Colitis patients with septic shock have a higher mortality than their perforated counterparts. A case report and review of literature. International Journal of Surgery Case Reports (2022).
About these summaries
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