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. 2025 May 21;17(5):e84519.
doi: 10.7759/cureus.84519. eCollection 2025 May.

Prognostic Factors Associated With Treatment Failure in Uncomplicated Stercoral Colitis at an Emergency Department: A Retrospective Cohort Study

Yuji Okazaki  1   2 , Toshihisa Ichiba  1 , Yuki Kataoka  3   2   4
Affiliations

Prognostic Factors Associated With Treatment Failure in Uncomplicated Stercoral Colitis at an Emergency Department: A Retrospective Cohort Study

Yuji Okazaki et al. Cureus. .

Abstract

Background: Stercoral colitis (SC) can potentially lead to bowel ischemia, sepsis, and perforation. While physicians have increasingly recognized the clinical importance of this condition, the risk of progression in patients with uncomplicated SC who do not have indications for emergency surgery remains unclear. The aim of this study was to determine prognostic factors associated with treatment failure in patients with uncomplicated SC in an emergency care setting.

Methods: We conducted a retrospective cohort study at a tertiary care hospital from April 2013 to March 2023. We included patients aged 18 years or older who were diagnosed with uncomplicated SC based on computed tomography (CT) at the emergency department. We analyzed the following prognostic factors: age, frailty, rebound tenderness, serum amylase level, and D-dimer level. We also analyzed the following CT findings: location of impacted fecaloma, maximum axial diameter and thickening of the affected colon, and the presence of pneumatosis coli and free fluid. The primary outcome was treatment failure, defined as the need for conversion from conservative treatment to emergency surgery or progression to in-hospital death. We used univariate logistic regression analysis to estimate odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Of the 117 patients identified, 15 patients (13%) had treatment failure. The presence of rebound tenderness (crude OR 57, 95% CI 10-330) and CT findings of pneumatosis coli (crude OR 4.7, 95% CI 1.5-14) and free fluid (crude OR 6.5, 95% CI 2.0-21) were associated with treatment failure. Frailty and results of blood examinations were not associated with poor outcomes.

Conclusion: A substantial number of patients with uncomplicated SC progressed to requiring emergency surgery or died. Physical signs of peritonitis and specific CT findings may aid in the identification of high-risk patients who require closer monitoring and potential surgical intervention.

Keywords: computed tomography (ct ); failure treatment; peritonitis; poor prognostic factor; stercoral colitis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Patient flow chart
Figure 2
Figure 2. Representative computed tomography findings in a patient with uncomplicated stercoral colitis
(A) Computed tomography (CT) image showing fecal impaction in the sigmoid colon (yellow arrowhead). (B) CT image showing pericolic fat stranding (yellow arrowhead) and wall thickening of the dilated segment of the descending colon (yellow arrow).
See this image and copyright information in PMC

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