1740. Stercoral Colitis: Clinical Risk Factors and CT Imaging Findings
Authors * Denotes Presenting Author
  1. Nicholas Zacharias *; University of Wisconsin School of Medicine and Public Health
  2. Meghan Lubner; University of Wisconsin School of Medicine and Public Health
  3. Elizabeth Richards; University of Wisconsin School of Medicine and Public Health
  4. Lu Mao; University of Wisconsin School of Medicine and Public Health
  5. Perry Pickhardt; University of Wisconsin School of Medicine and Public Health
To describe and update stercoral colitis clinical risk factors, incidence, location, and CT imaging features correlated with surgical and pathologic results.

Materials and Methods:
CT reports over a 5-year period (05/2017-05/2022) at a single medical center were searched. Main inclusion criteria were luminal distention with formed stool, wall thickening, and surrounding inflammation (distinct from diverticulitis and other causes of colitis). Positive cases were graded as mild versus moderate-severe (including perforation) based on CT findings. Medical records were further reviewed for risk factors and outcome data in moderate-severe cases.

545 total cases with CT findings compatible with stercoral colitis were identified, including 452 mild (83%) and 93 moderate-severe cases (17%). 20 moderate-severe cases showed evidence of perforation (4% total cohort, 22% of moderate-severe cohort). Based on primary indication for CT imaging, 46% of mild cases were considered incidental findings. Among moderate-severe cases, mean age was 67.2±17.7, with a female-to-male ratio of 1.12. Stercoral colitis primarily involved the rectum (94%, n=511); the sigmoid was involved in only 7.7%% (n=42), including 24 cases without rectal involvement. However, sigmoid involvement was observed in 95% (19/20) of all perforated cases, including 13 cases without rectal involvement (p< 0.00001, sigmoid vs. non-sigmoid involvement in perforation). Among the moderate-to-severe cohort, the perforated cohort showed slightly increased wall thickness (6.4 mm vs. 5.7 mm, p=0.029). Perforation was less associated with major neurocognitive disorders (20% vs. 60.3%, p=0.003), institutionalized status (5% vs. 38.4%, p=0.0052), and the presence of a prescribed bowel regimen (30% vs. 63%, p=0.0112). However, perforation was more associated with opioid use (50% vs. 23.3%, p=0.04). Mortality associated with stercoral colitis among perforated cases was 10.5% (n=2/19), significantly increased compared to the non-perforated cohort (p=0.041).

With increased prevalence of co-morbidities and opioid use, stercoral colitis may now be more common than previously appreciated. Perforation tends to favor sigmoid involvement and appears to affect a patient cohort lacking some of the traditionally described risk factors.