Mission Disimpaction: Endoscopic Management of Stercoral Colitis in an Adolescent

Abstract

Stercoral colitis is a rare entity of inflammatory colitis with high morbidity and mortality attributable to colonic fecaloma impaction, often a result of chronic constipation. Despite demographic imbalance favoring elders, children hold comparative risk factors for chronic constipation. Suspicion for stercoral colitis is warranted in nearly every stage of life. Computerized tomography (CT) is diagnostic for stercoral colitis, where radiological findings correlate to high sensitivity and specificity. Difficulty exists discerning from other acute and chronic intestinal etiologies with overlapping nonspecific symptoms and laboratory markers. Management involves prompt risk assessment for perforation and immediate disimpaction to avoid ischemic injury, with endoscopic directed disimpaction standard of care for nonoperative measures. Our case describes stercoral colitis in an adolescent with contributive risk factors for fecaloma impaction and is one of the first adolescent case reports involving successful endoscopic management.

FIGURE 1.

Computerized tomography axial view displaying a large rectal stool burden (*) with features for rectal wall thickening and submucosal enhancement (X).

FIGURE 2.

Endoscopic view post-disimpaction of rectosigmoid with presence of mucosal erythema and numerous clustered ulcerations where the fecaloma resided.