Stercoral Perforation of the Colon during Pregnancy: A Case Report and Review of the Literature

Abstract

Stercoral perforation of the colon, though rare, is associated with high mortality. Review of the literature identified only three prior cases reported during pregnancy. We report a case on a multiparous female presenting at 31 weeks of gestation with acute abdominal pain. Computed tomography suggested a sigmoid colon perforation. An urgent exploratory laparotomy was performed where feculent peritonitis and a stercoral perforation of the sigmoid colon was confirmed. A cesarean delivery and sigmoid colectomy with descending end colostomy was performed. While the newborn had an uncomplicated course, the mother developed an intra-abdominal abscess requiring operative management.

Keywords

colonic perforation - pregnancy - stercoral perforation

• References

• 1 Serpell JW, Nicholls RJ. Stercoral perforation of the colon. Br J Surg 1990; 77 (12) 1325-1329
• 2 Matsushita T, Yumoto Y, Fukushima K , et al. Stercoral perforation of the colon during pregnancy. J Obstet Gynaecol Res 2011; 37 (11) 1685-1688
• 3 Chakravartty S, Chang A, Nunoo-Mensah J. A systematic review of stercoral perforation. Colorectal Dis 2013; 15 (8) 930-935
• 4 Maurer CA, Renzulli P, Mazzucchelli L, Egger B, Seiler CA, Büchler MW. Use of accurate diagnostic criteria may increase incidence of stercoral perforation of the colon. Dis Colon Rectum 2000; 43 (7) 991-998
• 5 Kumar P, Pearce O, Higginson A. Imaging manifestations of faecal impaction and stercoral perforation. Clin Radiol 2011; 66 (1) 83-88
• 6 Hsiao TF, Chou YH. Stercoral perforation of colon: a rare but important mimicker of acute appendicitis. Am J Emerg Med 2010; 28 (1) 112.e1-112.e2
• 7 Likar R. Transdermal buprenorphine in the management of persistent pain - safety aspects. Ther Clin Risk Manag 2006; 2 (1) 115-125
• 8 Russell WL. Stercoraceous ulcer. Am Surg 1976; 42 (6) 416-420
• 9 Sung JF, Salvay HB, Hansman MF, Taslimi MM. Stercoral perforation of the colon with favorable pregnancy outcome. Obstet Gynecol 2009; 113 (2 Pt 2) 491-492
• 10 Israel GM, Malguria N, McCarthy S, Copel J, Weinreb J. MRI vs. ultrasound for suspected appendicitis during pregnancy. J Magn Reson Imaging 2008; 28 (2) 428-433
• 11 Furukawa A, Sakoda M, Yamasaki M , et al. Gastrointestinal tract perforation: CT diagnosis of presence, site, and cause. Abdom Imaging 2005; 30 (5) 524-534
• 12 Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 1998; 338 (3) 141-146
• 13 Lazarus E, Mayo-Smith WW, Mainiero MB, Spencer PK. CT in the evaluation of nontraumatic abdominal pain in pregnant women. Radiology 2007; 244 (3) 784-790
• 14 Singh JP, Steward MJ, Booth TC, Mukhtar H, Murray D. Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl 2010; 92 (3) 182-188
• 15 Maniatis V, Chryssikopoulos H, Roussakis A , et al. Perforation of the alimentary tract: evaluation with computed tomography. Abdom Imaging 2000; 25 (4) 373-379
• 16 ACOG Committee Opinion No. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004; 104 (3) 647-651