Stercoral perforation in a child: a rare complication of NSAID use

Abstract

The adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) on the gastrointestinal (GI) tract are well known. However, NSAID use rarely leads to a stercoral perforation, an extremely rare but life-threatening cause of acute abdomen. We present a case of stercoral sigmoid colon perforation in a 2-year-old girl, secondary to unintentional NSAID overdose, developing as a result of miscommunication between the general practitioner (GP) and the mother. To the best of our knowledge, stercoral perforation has never before been reported in a child.

Figure 1

Anteroposterior (AP) coronal CT scan image showing a faecolma in the pelvis (arrow) and free air under the diaphragm (arrow head).

Figure 2

Contrast-enhanced axial CT scan demonstrates a faecaloma in the proximal sigmoid colon (white arrow head) and at the site of the perforation, with colonic wall thickening (white arrowhead) due to pressure necrosis. Ascitic fluid between the liver and the abdominal wall (black arrow), pneumotosis, portal and retroperitoneal air, and a mild pneumoperitoneum (asterisk) can also be seen.

Figure 3

Contrast-enhanced axial CT scan showing a mild enhancement of the rectal and sigmoid mucosa with a small pocket of retroperitoneal air at the rectosigmoid junction.