Stercoral perforation of the rectum with faecal peritonitis and pneumatosis coli: A case Report

Abstract

Colonic perforation due to impacted faeces or faecaloma is a relatively uncommon presentation with grave prognosis. If left untreated, it can be life threatening due to complications like faecal peritonitis. Till date, fewer than 150 cases have been reported mostly in the English surgical literature describing constipation as the most common underlying etiology. Involvement of rectum is rare with very limited data published in this context. We present a case of stercoral perforation involving the rectum with associated faecal peritonitis and pneumatosis coli.

Keywords: Constipation; Perforation; Peritonitis; Pneumatosis; Rectum.

Figure 1

79 year old female with stercoral perforation of the rectum. Findings: Supine x-ray (A) and magnified views (B and C) shows significant amount of fecal matter within the pelvis (white arrow). Extraluminal air can be seen around sigmoid colon (arrowheads). Feeding gastrostomy is also noted (block arrow). Technique: Frontal radiograph of Abdomen in supine position. Difficult examination because of spinal deformity and rotation of patient.

Figure 2

79 year old female with stercoral perforation of the rectum. Findings: CT abdomen with IV contrast, Axial section in soft tissue window (A), in bone window (B), Coronal (C) and Sagittal (D) reformatted images show defect in anterior wall of rectum (arrow), extraluminal air and faecal contents around sigmoid colon (asterisk). Gastrostomy tube also seen in situ (arrowhead). Technique: 120 kV, 200 mAs, slice thickness 1.25 mm, IV contrast 70 ml Omnipaque 300, Rectal contrast 100 ml/in 600 ml of water.

Figure 3

79 year old female with stercoral perforation of the rectum. Findings : CT abdomen with rectal contrast - Axial (A and B), Coronal (C) and Sagittal (D) reformatted images show defect in anterior wall of rectum (white arrow), free extraluminal air around sigmoid colon(white star), leakage of rectal contrast through the defect (arrowhead). Technique: 120 kV, 200 mAs, slice thickness 1.25 mm, IV contrast 70 ml Omnipaque 300, Rectal contrast 100 ml/ in 600 ml of water.

Figure 4

79 year old female with stercoral perforation of the rectum. Findings: Intra -operative picture demonstrating bluish discoloration of rectum suggestive of gangrene (straight arrow), air bubbles seen within the wall of sigmoid colon i.e. pneumatosis coli (curved arrow).