Stercoral perforation
Presentation
Abdominal distension. Peritonitic.
Patient Data
Moderate volume pneumoperitoneum. The largest volume of air lies in the rectouterine pouch.
Marked fecal loading with the single largest fecolith measuring 5cm in the proximal sigmoid. I suspect the sigmoid is the site of perforation.
Inflammatory change and small volume free fluid in the peritoneum.
Small bowel feces sign in the distal ileum.
Solid organs normal.
Small bilateral pleural effusions and consolidation.
Histopathology Report
Clinical Details: Stercoral perforation - sigmoid colon.
Specimen: Sigmoid colectomy.
Macroscopic: One piece of sigmoid colon measuring 110 x 55 x 17 mm in depth. There is a staple on one resection margin and on the adjacent resection margin there is an area of perforation of the sigmoid colon measuring 23 x 10 x 5 mm deep. A few diverticulae are seen. Blocks: 1A = First resection margin (closest to perforation area) 1B = Other resection margin 1C = Perforation area representative sample of tissue 1D - 1F = Background sigmoid colon. 1G&1H = Mesentery / fatty tissue
Microscopic: This is large bowel with attenuated and flattened mucosa over the majority of the segment. The area of perforation of sigmoid colon is confirmed with fibrin, acute inflammation and faecal material on the external surface. There is no evidence of dysplasia or invasive neoplasia. Both margins are viable.
Diagnosis: Sigmoid colectomy - Benign sigmoid colon with stercoral perforation
Case Discussion
Multimodality appearances of a stercoral perforation. This is younger than the typical age for this condition, which is largely in the elderly.
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