Presentation
Long history of constipation. Acute left lower quadrant pain. Raised inflammatory markers. tenderness on examination.
Patient Data
Large volume of solid fecal matter throughout the distal colon. A solid piece of feces has extruded through the sigmoid colon into the adjacent mesentery, and there is also some free gas in this region, but no generalized pneumoperitoneum. A small volume of free fluid is also seen in the pelvis. No diverticulosis. Appearances consistent with stercoral colitis complicated by perforation.
HISTOLOGY REPORT
Clinical History: Stercoral perforation of sigmoid colon, Hartmann's procedure.
Macroscopic: Length of sigmoid colon, measuring 120 mm. Perforation present measuring 45 approximately, with associated FPE. On slicing, no focal pathology seen.
Microscopic: The representative sections of perforation consist of colonic mucosa, which demonstrates normal crypt architecture. Areas of acute inflammation are seen within the submucosa along with areas of hemorrhagic change. The resection margins consist of normal colonic mucosa. There is no evidence of dysplasia or malignancy. There is no evidence of inflammatory processes such as inflammatory bowel disease or infection. Overall, the histological features are consistent with the clinical diagnosis of stercoral perforation.
Conclusion: Sigmoid colon - features consistent with stercoral perforation.
Case Discussion
Chronic pressure on the bowel wall by the hard inspissated fecal matter may lead to ischemia, necrosis and finally perforation.
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