A Case of Stercoral Perforation of the Rectum Presented with Binswanger's Disease after Surgery

A 75-year-old man admitted for sudden abdominal pain following constipation for a week was found to have localized peritonitis in the left lower abdomen. Abdominal computed tomography (CT) showed impressive dilation of the sigmoid colon and the rectum containing massive amounts of stool, but no signs of perforation, suggesting conservative therapy. The next day, massive elevation of inflammatory markers and extrarectal escape of stool were seen on CT. Generalized peritonitis due to colorectal perforation was diagnosed and emergency surgery was conducted, revealing an oval 4.0 centimeter perforation in the right wall of the rectum and intramesenteric stool escape. We conducted Hartmann's operation. Although the patient suffered from multiple organ failure and postoperative wound and intraabdominal infection, he recovered, but prolonged neurological and mental symptoms led to a diagnosis of Binswanger's disease based on clinical findings and brain CT. He was transferred elsewhere on postoperative day 80 because neurological and mental symptoms were fixed. In sudden abdominal pain following persistent constipation in elderly patients with dementia, colorectal stercoral perforation must be considered and, if present, diagnosed early and treated promptly.