Stercoral perforation of the colon.
A 76-year old woman admitted with a six-day history of increasing
abdominal pain. Two weeks earlier she had undergone a total knee
replacement and at the time of her readmission was convalescing from
this procedure. Her bowels had not worked for 8 days. On examination
she had a temperature of 38°C and a generalised peritonitis. At
operation she had stercoral ulceration of the sigmoid colon with faecal contamination of the peritoneal cavity. The photograph shows the ulcerated section of sigmoid colon with faecal material visible. She was grossly constipated. A Hartmann's procedure (sigmoid colectomy with end-colostomy) was performed.
Comment: stercoral ulceration is a rare cause of colonic perforation, responsible for less that 3% of all perforations. Not treated promptly, this condition is associated with a high mortality.
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