Necrotic stercoral colitis: Importance of computed tomography findings

Table 1 Clinical data of study patients with necrotizing stercoral colitis

No.	Age (yr)/sex	sBP	BT	Hx	Cor	PS	WBC	TI	Fe	Pe	Operation findings	Pathology	Outcome
1	76/M	183	38.4	+	DM, HTN	-	22.2k/89	5’30’’	RS	No	Ischemic change from sigmoid to rectum with necrotic mucosa	Ischemia necrosis with mucosal sloughing	Alive
					Arrhythmia
2	86/M	130	34.4	+	CAD	-	45.6k/72	2’30”	S	S	Necrosis of descending and sigmoid colon with a 2-cm perforation	Perforating ulcer with transmural necrosis	Dead, 1 d after CT
					RF
3	79/F	147	36.1	+	DM	-	15.3k/76	7 d	D	D	Necrosis of nearly entire colon, with a 1.7-cm perforation	Mucosal ulcer with perforation	Dead, 19 d after CT
4	87/M	158	35.6	+	HTN	+	14.4k/90	4’40”	RS	S	A 2-cm perforator 2 cm proximal to the recto-sigmoid colon cancer	Transmural necrosis with a 2.1 cm perforator	Alive
5	80/F	120	33.6	+	HTN	-	3.6k/67	24’30”	S	S	Nearly entire colon necrosis with a 5-cm × 3-cm perforator at sigmoid colon	Ulcerative hole with transmural necrosis at sigmoid colon	Dead, 5 d after CT
6	70/F	145	36.4	+	DM	-	13.3k/80	15’40”	RS	No	Necrosis of distal ileum and entire colon	Transmural necrosis of bowel wall	Dead, 47 d after CT
7	88/F	81	35.0	+	-	-	4k/38	3’	RS	S	2 small perforators at proximal sigmoid colon	Gangrenous change with transmural necrosis of sigmoid colon	Dead, 8 d after CT
8	39/M	64	38.0	NA	ESRD	+	9.9k/79	26’	RS	No	Ischemic patches over sigmoid colon with impending perforation	Ischemic and gangrenous change of the sigmoid coon	Dead, 3 d after CT
9	83/M	158	37.0	NA	ARDS, HF HTN, COPD	-	17k/93	11’	RS	No	Ischemic change of small bowel and sigmoid colon	Transmural necrosis of sigmoid colon and mucosal necrosis of small bowel	Dead, 11 d after CT
10	83/M	64	35.3	+	CAD, HTN	-	46k/83	10’	RS	No	Patch necrosis of the T and D colon	Gangrenous change of the T and D colon	Alive

sBP: Systemic blood pressure (mmHg); BT: Body temperature (°C); Hx: History of constipation; Cor: Comorbidity; PS: Peritoneal signs at initial admission physical examination; WBC: White blood cell (number/percentage of segment) at admission; CT: Computed tomography; TI: Time interval between CT and surgery; Fe: Stool obstructive site; Pe: Perforator site; CAD: Coronary arterial disease; RF: Renal failure; HTN: Hypertension; HF: Heart failure; NA: Not applicable; -: Absent; +: Present; 5’30”: 5 h and 30 min, etc.; RS: Recto-sigmoid colon; S: Sigmoid colon; T: Transverse colon; D: Descending colon; DM: Diabetes mellitus; ESRD: End-stage renal disease; ARDS: Acute respiratory distress syndrome; COPD: Chronic obstructive pulmonary disease.

Table 2 Imaging signs of necrotizing stercoral colitis

No.	Radiographic abnormal gas	CT signs
		Fecal impaction	Obstructive site	Proximal dilatation	Wall thickening	Dense mucosa	Mucosal sloughing	Perfusion defect	Pericolonic stranding	Abnormal gas	Pneumo-mesocolon	Abscess
1	N	Y	RS	N	N	NA	N	Y	Y	N	N	N
2	Y	Y	S	N	Y	NA	N	Y	N	Y	Y	N
3	N	Y	D	N	N	Y	N	N	Y	Y	N	N
4	N	Y	RS	N	Y	Y	N	Y	Y	Y	Y	Y
5	N	Y	S	N	Y	Y	N	Y	Y	Y	N	N
6	N	Y	RS	Y	Y	Y	N	Y	N	N	N	N
7	N	Y	RS	N	Y	Y	Y	Y	Y	Y	N	Y
8	N	Y	RS	Y	N	N	N	N	Y	N	N	N
9	N	Y	RS	N	Y	N	N	Y	Y	N	N	N
10	N	Y	RS	N	N	N	N	N	Y	N	N	N
Frequency	1/5 (20%)	10/10 (100%)	9/10 (90%)	2/10 (20%)	6/10 (60%)	5/8 (62.5%)	1/10 (10%)	7/10 (70%)	8/10 (80%)	5/10 (50%)	2/5 (40%)	2/10 (20%)
κ-value	1	1	1	1	0.4	0.714	0.615	0.286	0.737	0.8	1	1

CT: Computed tomography; NA: Not applicable; N: No; Y: Yes; RS: Recto-sigmoid colon; S: Sigmoid colon; D: Descending colon.