In this Image in Clinical Medicine from the New England Journal of Medicine, colonic distention, mural thickening, and perirectal fat stranding are seen on CT imaging in a man with autism and severe constipation.
The authors describe a young man with autism and severe constipation who presented with abdominal pain, nausea, and vomiting. Given the CT findings, clinicians diagnosed the patient with stercoral colitis.
While clinicians should always keep in mind more-common inflammatory intestinal processes, such as diverticulitis, appendicitis, infectious enteritis, or inflammatory bowel disease, radiographic evidence of inflammation (mural thickening, fat stranding) in the context of fecal impaction implies bowel ischemia and the diagnosis of stercoral colitis. Fecal impaction can cause mural pressure necrosis, which can progress to perforation and peritonitis if not promptly managed. Stercoral colitis is uncommon but can be life-threatening. Pa…
Comment
The authors describe a young man with autism and severe constipation who presented with abdominal pain, nausea, and vomiting. Given the CT findings, clinicians diagnosed the patient with stercoral colitis.
While clinicians should always keep in mind more-common inflammatory intestinal processes, such as diverticulitis, appendicitis, infectious enteritis, or inflammatory bowel disease, radiographic evidence of inflammation (mural thickening, fat stranding) in the context of fecal impaction implies bowel ischemia and the diagnosis of stercoral colitis. Fecal impaction can cause mural pressure necrosis, which can progress to perforation and peritonitis if not promptly managed. Stercoral colitis is uncommon but can be life-threatening. Pa…