Presentation
Acute abdominal pain, long history of constipation
Patient Data
Age: 90 years
Gender: Male
From the case:
Stercoral perforation
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CT study shows the following:
- marked distention of the rectum and sigmoid colon measure up to 9 cm diameter seen loaded with fecal matter and gases
- A moderate amount of free intraperitoneal gas (pneumoperitoneum) seen at the perihepatic, peri colonic, in between bowel loops, around the distended sigmoid and seen extending to the right retroperitoneal and inguinal regions
- blurred peritoneal fat planes
- atherosclerotic changes of the abdominal aorta and its splanchnic branches are seen involving celiac, superior mesenteric, and inferior mesenteric arteries and their branches show intimal thickening and mural irregularities, however no occlusion
- The proximal small bowel loops show adequate luminal opacification with oral contrast given through the NGT. No detectable leakage of contrast
- A cluster of small cysts are seen involving the pancreatic head measures 3.3x2.7 cm possibly related to cystic pancreatic neoplasm
- the lower chest cuts show bilateral basal pneumonitis
From the case:
Stercoral perforation
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Arrows point to the pneumoperitoneum
Case Discussion
Here is a case of stercoral perforation which is a bowel perforation due to pressure necrosis from a fecal mass (fecaloma). It is an uncommon, but life-threatening, and can be a cause of acute abdomen secondary to fecal peritonitis.
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