Brief Article
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World J Gastroenterol. Jan 21, 2011; 17(3): 379-384
Published online Jan 21, 2011. doi: 10.3748/wjg.v17.i3.379
Necrotic stercoral colitis: Importance of computed tomography findings
Cheng-Hsien Wu, Li-Jen Wang, Yon-Cheong Wong, Chen-Chih Huang, Chien-Cheng Chen, Chao-Jan Wang, Jen-Feng Fang, Chuen Hsueh
Cheng-Hsien Wu, Li-Jen Wang, Yon-Cheong Wong, Chen-Chih Huang, Chien-Cheng Chen, Chao-Jan Wang, Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 333 Taoyuan, Taiwan, China
Jen-Feng Fang, Division of Trauma and Emergency, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 333 Taoyuan, Taiwan, China
Chuen Hsueh, Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, 333 Taoyuan, Taiwan, China
Author contributions: Fang JF was the surgical consultant; Hsueh C was the pathological consultant; Wu CH, Wong YC and Wang LJ were involved in editing the manuscript; Huang CC, Chen CC and Wang CJ performed the image interpretation; Wu CH and Wong YC designed the study and wrote the manuscript.
Correspondence to: Dr. Yon-Cheong Wong, Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Gueishan, 333 Taoyuan, Taiwan, China. ycwong@adm.cgmh.org.tw
Telephone: +886-3-3281200 Fax: +886-3-3970074
Received: July 23, 2010
Revised: September 2, 2010
Accepted: September 9, 2010
Published online: January 21, 2011
Abstract

AIM: To study the computed tomography (CT) signs in facilitating early diagnosis of necrotic stercoral colitis (NSC).

METHODS: Ten patients with surgically and pathologically confirmed NSC were recruited from the Clinico-Pathologic-Radiologic conference at Chang Gung Memorial Hospital, Taoyuan, Taiwan. Their CT images and medical records were reviewed retrospectively to correlate CT findings with clinical presentation.

RESULTS: All these ten elderly patients with a mean age of 77.1 years presented with acute abdomen at our Emergency Room. Nine of them were with systemic medical disease and 8 with chronic constipation. Seven were with leukocytosis, two with low-grade fever, two with peritoneal sign, and three with hypotensive shock. Only one patient was with radiographic detected abnormal gas. Except the crux of fecal impaction, the frequency of the CT signs of NSC were, proximal colon dilatation (20%), colon wall thickening (60%), dense mucosa (62.5%), mucosal sloughing (10%), perfusion defect (70%), pericolonic stranding (80%), abnormal gas (50%) with pneumo-mesocolon (40%) in them, pericolonic abscess (20%). The most sensitive signs in decreasing order were pericolonic stranding, perfusion defect, dense mucosal, detecting about 80%, 70%, and 62.5% of the cases, respectively.

CONCLUSION: Awareness of NSC and familiarity with the CT diagnostic signs enable the differential diagnosis between NSC and benign stool impaction.

Keywords: Fecal impaction, Dense mucosa, Pericolonic stranding, Stercoral colitis, Computed tomography