eP494 - Stercoral Colitis in Pregnancy Leading to Perforation: A Case Report

Purpose/Background: Constipation is a known, common side effect of pregnancy. In some circumstances, severe constipation can lead to stercoral colitis, inflammation caused by increased intraluminal pressure on the mucosa of the colon. In rare instances, stercoral colitis can lead to perforation. This is a case report of severe constipation leading to colonic perforation in a pregnant woman.Methods/Interventions: A 31 year old woman who was 26 weeks, 6 days gestation presented to the hospital with abdominal pain for several days. After excluding preterm labor, she underwent ultrasound and MRI to rule out appendicitis, which were negative. She had noted constipation throughout her pregnancy and experienced days without a bowel movement. She had a significant family history of irritable bowel syndrome with constipation (IBS-C) in her mother and sister, but she had no known documented GI history. She was initiated on a bowel regimen including Colace, Miralax, Dulcolax suppositories, and enemas. After an enema, several days into her admission, she developed severe abdominal pain. A chest Xray demonstrated pneumoperitoneum and patient was emergently brought for an emergency c-section and exploratory laparotomy. After the fetus was delivered from the uterus, exploration of the abdomen demonstrated inflamed descending colon with a perforation and evacuation of hard stool from the colotomy. Severe constipation throughout the colon and serosal injury at the splenic flexure were also identified. After mobilizing the descending colon and the splenic flexure, the distal transverse to mid descending colon was resected. Midline abdomen was closed with running 1-PDS and skin closed with staples. A transverse colostomy was matured in the left upper quadrant. Postoperatively, the patient remained hospitalized for several days until she was tolerating a diet and her colostomy was functioning. Pathology demonstrated transmural inflammation with mucosal ulceration of the descending colon.Results/Outcomes: .Conclusion/

Discussion: Severe constipation can lead to stercoral colitis, even in pregnancy. In addition to common causes of abdominal pain during pregnancy, stercoral colitis should be included as a differential diagnosis; colon perforation can be life threatening for the patient and the fetus.MR AbdomenMR abdomen demonstrating colonic distension and constipation.