Value of CT in the discrimination of fatal from non-fatal stercoral colitis

Abstract

Objective: Clinical presentation and physical signs may be unreliable in the diagnosis of stercoral colitis (SC). This study evaluates the value of computed tomography (CT) in distinguishing fatal from non-fatal SC.

Materials and methods: Ten patients diagnosed as SC were obtained from inter-specialist conferences. Additional 13 patients with suspected SC were identified via the Radiology Information System (RIS). These patients were divided into two groups; fatal and non-fatal SCs. Their CT images are reviewed by two board-certified radiologists blinded to the clinical data and radiographic reports.

Results: SC occurred in older patients and displayed no gender predisposition. There was significant correlation between fatal SC and CT findings of dense mucosa (p = 0.017), perfusion defects (p = 0.026), ascites (p = 0.023), or abnormal gas (p = 0.033). The sensitivity, specificity, and accuracy of dense mucosa were 71%, 86%, and 81%, respectively. These figures were 75%, 79%, and 77% for perfusion defects; 75%, 80%, and 78% for ascites; and 50%, 93%, and 78% for abnormal gas, respectively. Each CT sign of mucosal sloughing and pericolonic abscess displayed high specificity of 100% and 93% for diagnosing fatal SC, respectively. However, this did not reach statistical significance in diagnosing fatal SC.

Conclusion: CT appears to be valuable in discriminating fatal from non-fatal SC.

Keywords: Computed tomography; Fatality; Fecaloma; Stercoral colitis.

Fig. 1

Enhanced abdomen CT for 71-year-old woman with non-fatal SC demonstrating wall thickening (arrowhead) at recto-sigmoid colon, discontinuation of enhanced mucosa that indicates perfusion defect (white arrow). Regional ascites accumulation (black arrow) is also seen. SC = stercoral colitis

Fig. 2

Fatal stercoral colitis in 79-year old woman. A. Un-enhanced CT showing dense rim conforming to wall of sigmoid colon impressed as dense mucosa (white arrow). Increased streaky pericolic infiltration (arrowhead) is also seen. B. Note presence of mucosal hemorrhage and marked submucosal congestion of tissue specimen.

Fig. 3

Enhanced abdomen CT for 88-year-old woman with fatal SC revealing mucosal slip (arrow) sloughing out from wall of distended colon. Surgical resection confirmed SC with gangrene mucosa in sloughing. SC = stercoral colitis

Fig. 4

Enhanced CT for 87-year-old man with non-fatal SC revealing confined mottled substance abutting sigmoid colon (arrow), indicative of perisigmoid abscess formation. Extra-luminal gas (white arrowhead) around the sigmoid colon is also seen. SC = stercoral colitis