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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Stercoral perforation of the cecum: A case report
Hung-Chun Yu, Ta-Wei Pu, Jung-Cheng Kang, Chao-Yang Chen, Je-Ming Hu, Ruei-Yu Su
Hung-Chun Yu, Department of Surgery, Taichung Armed Forces General Hospital, Taichung 411228, Taiwan
Hung-Chun Yu, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
Ta-Wei Pu, Chao-Yang Chen, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei 105, Taiwan
Jung-Cheng Kang, Division of Colon and Rectal Surgery, Department of Surgery, Taiwan Adventist Hospital, Taipei 105, Taiwan
Je-Ming Hu, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Ruei-Yu Su, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 105, Taiwan
Ruei-Yu Su, Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
Author contributions: Yu HC, Pu TW, Kang JC, Chen CY, Hu JM, and Su RY designed and performed the research; Yu HC and Pu TW analyzed the data and wrote the manuscript; and all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ta-Wei Pu, MD, Chief Doctor, Doctor, Surgeon, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, No. 131 Jiankang Road, Taipei 105, Taiwan. tawei0131@gmail.com
Received: November 26, 2023
Peer-review started: November 26, 2023
First decision: December 11, 2023
Revised: January 11, 2024
Accepted: March 18, 2024
Article in press: March 18, 2024
Published online: April 27, 2024
BACKGROUND
With less than 90 reported cases to date, stercoral perforation of the colon is a rare occurrence. Stercoral ulceration is thought to occur due to ischemic pressure necrosis of the bowel wall, which is caused by the presence of a stercoraceous mass. To underscore this urgent surgical situation concerning clinical presentation, surgical treatment, and results, we present the case of a 66-year-old man with a stercoral perforation.
CASE SUMMARY
A 66-year-old man with a history of hypertension, hyperlipidemia, and gout presented at the emergency department with lower abdominal pain and a low-grade fever lasting for a few hours. Abdominal computed tomography indicated a suspected bezoar (approximately 7.6 cm) in the dilated cecum, accompanied by pericolic fat stranding, mild proximal dilatation of the ileum, pneumoperitoneum, and minimal ascites. Intraoperatively, feculent peritonitis with isolated cecal perforation were observed. Consequently, a right hemicolectomy with peritoneal lavage was performed. A histopathological examination supported the intraoperative findings.
CONCLUSION
In stercoral perforations, a diagnosis should be diligently pursued, especially in older adults, and prompt surgical intervention should be implemented.
Core Tip: Spontaneous perforations are classified as either stercoral or idiopathic based on underlying etiologic and pathologic factors. In this case, the operative findings and histopathology report led us to conclude that the perforation was stercoral. This perforation is characterized by a rounded or ovoid-shaped defect with underlying necrotic and inflammatory edges in the absence of significant injuries, obstructions, tumors, and diverticulosis. This condition is commonly observed in chronically ill patients at a rate of 47% in the sigmoid colon and 30% in the rectosigmoid colon. In this manuscript, we present a rare case of bezoar-induced stercoral perforation of the cecum.
