Stercoral Perforation of the Colon: Evaluation with Computed Tomography

An 88-year-old woman experienced fever, chills, and severe left abdominal pain for 1 day. She had a history of chronic constipation and was bedridden. Non-enhanced abdominal computed tomography (CT) showed wall thickening of the descending colon, a 2-cm wall defect, pericolonic stranding, fecal material outside the colonic lumen, and pneumoperitoneum, and stercoral perforation of the descending colon was diagnosed preoperatively. An 83-year-old woman experienced lower abdominal tenderness and rebound pain. She had a long-term history of chronic constipation. Abdominal CT showed extraluminal air, especially around the sigmoid colon, dense mucosa (on non-enhanced CT), a 2-cm wall discontinuity of the sigmoid colon, pericolonic stranding, and extraluminal fecal material. Stercoral perforation of the sigmoid colon was diagnosed preoperatively. In both patients, stercoral perforation was confirmed during emergency surgery. The present report emphasizes the importance of an early CT diagnosis of stercoral perforation for decreasing the time interval between onset and surgery and reducing the risk of mortality. J Radiol Sci 2015; 40: 95-98 Correspondence Author to: Kwok-Wan Yeung Department of Radiology, Fooyin University Hospital, Pingtung, Taiwan No. 5, Chung-Shan Road, Tung-Kang, Pingtung 928, Taiwan 04_RAG_1708.indd 95 2015/12/9 下午 03:16:06 Stercoral perforation of colon 96 J Radiol Sci September 2015 Vol.40 No.3 Case 2 An 83-year-old woman experienced lower abdominal tenderness for 1 day. She had a long-term history of chronic constipation. Rebound abdominal pain was noted in the emergency department. Additionally, leukocytosis (white blood cell count, 14460/μL; band form, 6%) was noted. Abdominal CT showed extraluminal air, especially around the sigmoid colon, dense mucosa (on non-enhanced CT), a 2-cm wall discontinuity of the sigmoid colon, pericolonic stranding, and extraluminal fecal material (Fig. 2), and stercoral perforation of the sigmoid colon was diagnosed preoperatively. Emergency laparotomy confirmed the CT diagnosis of stercoral perforation, and a 2-cm perforation was noted at the sigmoid colon. Segmental resection of the sigmoid colon and Hartmann's procedure were performed. She had an uneventful course during 11 days of hospitalization.