Stercoral Perforation of the Colon: Report of Four Cases

There were four cases of stercoral perforation of the colon at Yokohama Municipal Citizen's Hospital. They were one male and three females with a mean age of 62.3 years. Three of them had been constipated until the onset. They developed sudden onset of abdominal pain associated with vomiting, followed by anal bleeding in one case and shock in two cases. Abdominal free air was recognized in only one case by plain abdominal X-ray, while accumulation of ascitic fluid was recognized in three cases by ultrasonography. All of them underwent emergency operation after the diagnosis of perforation of the digestive tract and generalized peritonitis. The site of perforation was rectosigmoid colon in all cases. A hard stool mass was found in either abdominal cavity or at the site of perforation, and a large amount of hard stool was present in the surrounding colon. Resection of the perforated segment, drainage and colostomy were performed in three of them, and exteriorization was performed in the remaining case. The postoperative course of the four cases was uneventful without serious complication. Perforated stercoral ulcer was either round or spherical in share macroscopically. and the surrounding of the perforation was compressed microscopically.