868 - Rare Stercoral Colitis With Concomitant High Fatality Rate, and Differentials Throughout Rehabilitative Care

This case explores the rare, yet highly fatal condition stercoral colitis in an elderly male post left above knee amputation.  It is not uncommon for individuals to transfer to a rehab facility without having a bowel movement for multiple days.   This individual was originally hospitalized for weakness, malaise, shortness of breath, and back pain.  He also had left great toe gangrene which ultimately led to the later amputation.  He transferred to the rehab facility but did not progress and continued with low grade abdominal discomfort, and hematochezia.  Abdominal X-ray was consistent with stool burden in an individual taking multiple pain medications.  Flexible sigmoidoscopy was consistent with hemorrhoids.  Due to continued low functional gains advanced abdominal imaging was therefore performed that portrayed stercoral colitis and with treatment he improved.

Discussions:

It is common to assume constipation can cause abdominal symptoms and treatment with laxatives is the mainstay.   Patients also arrive to facilities without having bowel movements for days.  However, it is important to be aware that a condition such as stercoral colitis exists which stems from constipation, and when impacted fecal material results in fecaloma formation and subsequent inflammation, it can be fatal.  This case explores the wide differential that exists with concomitant constipation.  It is important to know when to consider advanced diagnoses and in particular those that can be highly fatal.

Conclusions:

We'll review the literature on conditions that can cause abdominal or back discomfort, and algorithms to consider in individuals needing advanced care sooner rather than waiting for laxatives to take their course for constipation or motility disorders.  Essentially, it is important to familiarize oneself with less common conditions that have high fatality rates in a population where constipation is very common.