Successful Management of Septic Shock Secondary to Stercoral Colitis by Subtotal Colectomy

Abstract

A 69-year-old woman with a history of vertigo, recurrent vomiting, and dysarthria was transferred to our hospital. Physical examination revealed tachycardia, tachypnea, and abdominal distention without tenderness. Her neurological findings spontaneously disappeared. A head computed tomography (CT) and magnetic resonance imaging also revealed no abnormalities. However, a plain CT of the abdomen revealed fecal impaction in the sigmoid colon and rectum, and dilatation of the colon orad of the stricture. Six hours after admission, the patient developed transient loss of consciousness, following which examination revealed abdominal tenderness and guarding and signs of shock. A repeat abdominal CT showed no evidence of perforation. We diagnosed the patient as having septic shock complicating stercoral colitis and performed emergency surgery. During laparotomy, necrosis, abnormal coloration, and intestinal wall thinning extending from the cecum to the sigmoid colon were noted, and we performed a subtotal colectomy and ileostomy. The patient was discharged, and the stoma was closed on the 22nd and 110th postoperative days, respectively. Stercoral colitis is rare. Herein, we report a case of stercoral colitis with a review of the literature.