Episode 140: Stercoral Colitis

Stercoral colitis, an inflammatory condition of the large bowel, arises from chronic constipation and fecal impaction, leading to high intraluminal pressures that compress the bowel wall and vasculature. While often associated with older age and sedentary lifestyles, the condition frequently lacks a classic clinical presentation, making CT imaging with IV contrast essential for diagnosis. Management focuses on initial resuscitation followed by aggressive decompression through digital disimpaction, enemas, and oral bowel regimens. Given the high risk of complications like perforation, peritonitis, and sepsis—which carry mortality rates as high as 60%—early surgical consultation is critical. Even in uncomplicated cases, the potential for rapid progression and significant morbidity necessitates careful monitoring and inpatient admission to prevent severe outcomes such as bowel necrosis and septic shock.