eP101 - Stercoral Perforation of the Rectum

Purpose/Background: Stercoral Perforation often occurs due to mechanical compression of fecal matter which leads to ischemic mucosal necrosis, bacterial translocation, and ulceration. Approximately 20% of patients present with localized peritonitis, and 80% with generalized peritonitis. A significant risk factor for stercoral perforation is chronic constipation. This abstract highlights a patient with chronic constipation/fecal impaction, and NSAID use who presented with rectal perforation with gross feculent peritonitis (with fecalomas).Methods/Interventions: The patient was appropriately resuscitated (IV fluids, antibiotic coverage) in the ED. He was taken for an emergent Exploratory Laparotomy. Intra-operatively, an approximately 4 x 4 cm perforation was identified on the anterior upper aspect of the rectum. There was a significant amount of fecal material (with fecalomas) present throughout the peritoneal cavity, with purulent fluid noted in the pelvis, and paracolic gutter. The peritoneal cavity was washed out and feculent material was removed. Pt remained hemodynamically stable. Rectal perforation was repaired primarily, then a diverting loop ileostomy was created.Results/Outcomes: Postoperatively, the patient was managed in the ICU. The Ileostomy continued to be functional. His course was overall uncomplicated until POD 11. He developed a dehiscence of the midline abdominal wall fascia with no evisceration. He was taken to the OR for abdominal wall closure with retention sutures. On POD 18, a CT abdomen/pelvis was done to evaluate for interval changes and showed multiple fluid collections throughout the abdomen. Managed conservatively after evaluation by IR for drainage, noted drainage not indicated at that time.Conclusion/

Discussion: The right chest tube was eventually removed on POD 20 after the output continued to be minimal, and interval CXR’s showed resolution of the right pleural effusion. The patient's condition gradually improved, with daily wound care, ostomy care, nutritional intervention, and physical therapy. He was subsequently discharged with the necessary home services.CT abdomen/pelvis (sagittal)CT showing moderate amount of free intraperitoneal air anteriorly and above the liver, high fecal burden, pelvic free fluid with fecal material