Imaging Pearls ❯ Colon ❯ Stercoral Colitis
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- “Stercoral colitis (also called stercoral proctitis if limited to the rectum) is an inflammatory condition of the bowel wall caused by fecal impaction. The resulting fecaloma leads to focal dilation of the bowel lumen and increased intraluminal pressure. When the pressure compromises vascular perfusion, this may lead to pressure-induced necrosis. The complications of this condition may range from subtle inflammatory findings to ulceration and, ultimately, even perforation.”
Stercoral colitis: CT imaging findings and clinical risk factors
Nicholas A. Zacharias · Meghan G. Lubner · Elizabeth S. Richards · Lu Mao · Perry J. Pickhardt
Abdominal Radiology (2023) 48:3050–3062 
Stercoral colitis: CT imaging findings and clinical risk factors
Nicholas A. Zacharias · Meghan G. Lubner · Elizabeth S. Richards · Lu Mao · Perry J. Pickhardt
Abdominal Radiology (2023) 48:3050–3062- “Beyond age, other reported risk factors for fecal impaction and stercoral colitis include neurocognitive conditions (e.g., dementia, cerebral palsy, spinal cord injury), disorders of the gastrointestinal tract (e.g., idiopathic constipation, colorectal cancer, inflammatory bowel disease), metabolic conditions and derangements (e.g., diabetes, uremia, hypothyroidism), and sites of anatomic narrowing. Medications such as opioids, anti-psychotics, anti-epileptics, and others that affect bowel motility may also play a role.”
Stercoral colitis: CT imaging findings and clinical risk factors
Nicholas A. Zacharias · Meghan G. Lubner · Elizabeth S. Richards · Lu Mao · Perry J. Pickhardt
Abdominal Radiology (2023) 48:3050–3062 - Colonic segment involvement of stercoral colitis and measurements are recorded in Table 2. The most common location of stercoral colitis involvement was the rectum (93.8%, n = 511, including 18 rectosigmoid cases). The rectum alone (proctitis) was implicated in 95.8% of mild cases (n = 433). Of the moderate-to-severe cases, the rectum alone was implicated in 81% (n = 59) of the cases without perforation compared with only 5% (n = 1) of those with perforation (p < 0.001). Sigmoid colonic involvement portended a more advanced presentation and was involved in 95% (n = 19) of perforated cases, including 13 cases without rectal involvement. In comparison, the sigmoid was involved in 16% (n = 12) and 2.4% (n = 11) of the moderate-to-severe cases without perforation and mild cases, respectively (p <0.001).
Stercoral colitis: CT imaging findings and clinical risk factors
Nicholas A. Zacharias · Meghan G. Lubner · Elizabeth S. Richards · Lu Mao · Perry J. Pickhardt
Abdominal Radiology (2023) 48:3050–3062 - “CT imaging features used to identify stercoral colitis in this study including luminal distention, colonic wall thickening, and surrounding inflammatory changes were similar to those reported in prior literature. The threshold of ≥ 3 mm to define wall thickening was typically utilized in prior studies, though Wu et al. reported cases without evidence of wall thickening (n = 10/23). Furthermore, we observed increasing thickness associated with increasing severity of the case. Though not required for diagnosis, other studies had reported unique features such as upstream colonic dilation, mucosal sloughing, and mesenteric hyperemia. Though the latter two features were not observed, upstream dilatory effect was observed in most cases, with 11% of the total cohort demonstrating findings of diffuse colonic distension with gas or fecal contents based on CT imaging reports. Prior studies also demonstrated similar imaging features associated with perforation, including pneumoperitoneum, developing abscess, free fluid, or extraluminal gas and stool.”
Stercoral colitis: CT imaging findings and clinical risk factors
Nicholas A. Zacharias · Meghan G. Lubner · Elizabeth S. Richards · Lu Mao · Perry J. Pickhardt
Abdominal Radiology (2023) 48:3050–3062
- “Stercoral colitis is an inflammatory colitis related to increased intraluminal pressure from impacted fecal material in the colon. This rare condition, first reported in 1894, has been described primarily in the surgical and gastrointestinal literature . As a result of the fecal impaction (a large mass of dry, hard stool that can develop because of chronic constipation), a focal pressure colitis may occur with ulceration resulting in colonic perforation. When stercoral colitis is associated with colonic perforation, a 35% mortality rate has been reported.”
Stercoral Colitis Leading to Fatal Peritonitis: CT Findings Heffernan C et al. AJR 2005;184:1189–1193 - “The sequence of events that can lead to fa-
tal colonic perforation is the development of fecal impaction, which causes increased intraluminal and colonic wall pressure. If left untreated, ischemic ulceration and perforation can ensue.”
Stercoral Colitis Leading to Fatal Peritonitis: CT Findings Heffernan C et al. AJR 2005;184:1189–1193 - “Fecal impaction leading to colonic obstruction is seen primarily in the elderly, often those who live in nursing homes or, less often, young pa- tients who are neurologically impaired. There is also an association with opiates, tricyclic antidepressants, and tranquilizers, most of which slow transit time through the bowel. Approximately 60% of patients who present with fecal impaction have a history of chronic constipation.” Stercoral Colitis Leading to Fatal Peritonitis: CT Findings Heffernan C et al. AJR 2005;184:1189–1193
- “The three most common locations for ster- coral ulceration are the anterior rectum just proximal to the peritoneal reflection, the anti- mesenteric border of the rectosigmoid junc- tion, and the apex of the sigmoid colon. Most cases are described as occurring on the antimesenteric side of the bowel wall. A pos- sible explanation is that the blood supply to the bowel enters on the mesenteric side and is relatively poor on the antimesenteric side, predisposing to ischemia.”
Stercoral Colitis Leading to Fatal Peritonitis: CT Findings Heffernan C et al. AJR 2005;184:1189–1193 - “Because most cases of uncomplicated stercoral colitis are successfully treated with disimpaction, a histologic diagnosis is not often obtained. In most cases of uncomplicated fecal impaction, the colon
wall should be thin without adjacent fat stranding. The imaging findings of colonic wall thickening and pericolonic fat stranding suggest colitis. When associated with fecal impaction and in the right clinical setting, these findings should suggest stercoral colitis.”
Stercoral Colitis Leading to Fatal Peritonitis: CT Findings Heffernan C et al. AJR 2005;184:1189–1193 - “Necrotic stercoral colitis is a necrotic process that occurs in stercoral colitis (SC), caused by fecal impaction that results in pressure ulceration and regional necrosis. Perforation is rare, but has a mortality rate of 32%-57%. Early diagnosis with aggressive bowel cleansing and disimpaction may decrease the pressure and lessen the likelihood of ulceration of the colon. Fecal impaction frequently occurs in elderly patients, and those who are bed-ridden for a prolonged period of time.”
Necrotic stercoral colitis: Importance of computed tomography findings Cheng-Hsien Wu et al. World J Gastroenterol. 2011 Jan 21; 17(3): 379–384. - “Fecal impaction and perforation occur most often in the sigmoid colon. The sigmoid colon is the narrowest region of the entire colon, and passage of stools with a more solid consistency can be difficult. In such cases, fecaloma exerts localized pressure on the walls of the sigmoid colon, the area with the most precarious vascular supply, especially the vascular region known as Sudeck’s point. Prolonged localized pressure and ischemia can give rise to pressure ulceration.”
Necrotic stercoral colitis: Importance of computed tomography findings Cheng-Hsien Wu et al. World J Gastroenterol. 2011 Jan 21; 17(3): 379–384. - “NSC differs from other colitis by absence of diarrhea clinically. It can be confirmed by intraoperative and histological findings. At surgery, stercoral ulcers and perforations are usually found on the anti-mesenteric side; ulcerations usually have sharp margins and measure 1-10 cm, and are occasionally multiple. Histological findings include sharp demarcation without undermining at ulcer margins, and transmural necrosis at the perforated site. Treatment is usually resection of the affected bowel, colostomy, and Hartmann’s procedure.”
Necrotic stercoral colitis: Importance of computed tomography findings Cheng-Hsien Wu et al. World J Gastroenterol. 2011 Jan 21; 17(3): 379–384.