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0418 발표용
0418 발표용
0418 발표용
2008-04-18
R1
Case
@ 66/M
Present illness
Chronic constipation hx.
1 defecation .
3 epigastric discomfort.
abrupt periumbilical sever pain. Plain
abdomen x-ray free air transfer.
Pathology
Microscopic
Stercoral colitis
Definition
Inflammatory process of colonic wall
related to fecal impaction
Stercoral colitis
Mechanism
Conglomeration of dehydrated fecal material
Increased intraluminal pressure
Decreases blood supply
Ischemia ulceration and perforation
Nevertheless
Stercoral ulceration does not always occur among
constipation cases
Not every stercoral ulceration results in colon
perforation.
Stercoral colitis
Stercoral ulceration:
M/C in antimesenteric aspect of sigmoid colon
hypoperfusive status
decreasing water content in the stool
narrow diameter
high intraluminal pressures
CT Finding
Uncomplicated
fecal impaction
Stranding of
pericolonic fat
Presence of
-extraluminal
bubbles of gas
-abscess
Diagnosis
Hystory of chronic constipation or fecal impaction
Intraoperative findings
generalized peritonitis, colonic dilatation
colonic perforation size 1 cm or more
ulcerations on the antimesenteric border
If frank perforation occurs
-> fecal material within the peritoneal cavity
in close proximity to the perforation site
Histology
transmural necrosis
ulcer margins sharply demarcated
nonspecific inflammatory changes
no additional colonic pathology is found
Treatment
Most cases of uncomplicated stercoral colitis
successfully treated with disimpaction
Stercoral perforation
broad spectrum antibiotics : initiated in all the patient
resection of the colon segment with an end colostomy
primary repair
Underlying disease Tx
Mortality related to stercoral perforation
: 30% to 55% , prompt exploration may decrease that rate
Reference
Stercoral Colitis Leading to Fatal Peritonitis: CT
Findings Cathleen et al.
AJR 2005; 184:1189-1193