Stercoral ulceration
Stercoral perforation is defined as a bowel perforation due to pressure necrosis from a fecal mass (fecaloma). It is an uncommon, but life-threatening, complication of unresolved fecal impaction and can be a cause of acute abdomen secondary to fecal peritonitis.
Epidemiology
It may represent 3.2% of all colonic perforations and 2.2% of randomly-selected autopsy examinations . It generally occurs in older individuals .
Associations
Conditions causing chronic constipation, see article on fecaloma for list of associations and etiologies.
Pathology
The postulated pathogenesis is from a rise in intraluminal pressure which becomes greater than the capillary perfusion pressure within the bowel. This then results in focal ischemia, necrosis, ulceration, and ultimately perforation .
Location
It typically involves the rectosigmoid colon on the antimesenteric side in ~90% of cases .
Radiographic features
CT
A universal component in a stercoral perforation is the formation of a fecaloma which is a localized hard, inspissated, or calcified fecal mass, usually of a diameter equal to or greater than the colonic lumen (due to the lowest blood supply and narrowest diameter).
There is evidence of extraluminal gas +/- extruding fecal content. The site of perforation usually involves the antimesenteric border of the colon.
Treatment and prognosis
They can be life-threatening with mortality rates ranging between 30-55% .
Stercoral perforations are almost always free and open, although to some extent plugged by a fecaloma, hence unlikely to resolve spontaneously with conservative management.
See also
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Perforation bei Stuhlimpaktation:
