E5113. Stercoral Colitis: A Review of Imaging Features and Complications
  1. Bertin Mathai; North Shore-LIJ Northwell Health
  2. Douglas Katz; NYU Langone Long Island
  3. John Hines; Huntington Hospital Northwell Health
Stercoral colitis is an inflammatory process involving the colonic wall related to increased intraluminal pressure secondary to fecal impaction. The increased mechanical pressure can cause ulceration and ischemic necrosis, eventually leading to perforation, peritonitis, and death. A mortality rate of 35% has been reported with stercoral colitis complicated by perforation. The purpose of this exhibit is to familiarize radiologists with imaging features of uncomplicated and complicated stercoral colitis and its mimics.

Educational Goals / Teaching Points
1. Review the risk factors, pathophysiology, and clinical presentation of stercoral colitis. 2. Discuss the importance of early recognition of uncomplicated stercoral colitis. 3. Illustrate the imaging findings of complicated and uncomplicated stercoral colitis. 4.Review imaging mimics of stercoral colitis such as diverticulitis, infectious colitis, inflammatory bowel disease, and ischemic colitis. 5. Discuss the management of stercoral colitis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Abdominal radiographs may demonstrate nonspecific findings of sterocral colitis, such as large amounts of stool in rectum and/or sigmoid colon. Free intraperitoneal air on abdominal radiographs is indicative of perforated viscus; however, CT is a more sensitive modality for diagnosing stercoral colitis and its associated complications. Common CT findings of stercoral colitis include 1) stool filled and distended colon with focal colonic wall thickening, which represents edema from ulceration and ischemia; 2) pericolonic/presacral fat stranding of the involved segment secondary to ischemia; and 3) presence of localized extraluminal gas or bubbles, extraluminal stool collections, discontinuity of the colonic or rectal wall, and pneumoretroperitoneum or pneumoperitoneum in cases of perforation. Additional findings suggestive of perforation, such as portal venous or mesenteric gas, can be present.

Fecal impaction is a common presentation in patients with chronic constipation, especially the elderly, and, in a minority of cases, can lead to stercoral colitis, an inflammatory condition with potentially serious implications. Therefore, it is important as radiologists to recognize stercoral colitis in its early stages, allowing time for conservative management with disimpaction, and enemas/cathartics to prevent the life-threatening complications of perforation and feculent peritonitis.