A Case of Stercoral Colitis Complicated by Ischemic Colitis in a Young Female

Introduction: Stercoral colitis (SC) is an inflammatory colitis with a mortality rate of 35% when associated with ischemic colitis [1]. Complications of SC include ischemic necrosis, ulcer formation, and colonic perforation. SC complicated by colonic perforation can lead to septic shock with a mortality rate approaching 60% if an accurate diagnosis is not made promptly [2]. We present a case of SC complicated by ischemic colitis in a 28-year-old woman who presented with lower gastrointestinal bleeding. Case Description/Methods: A 28-year-old woman with a past medical history of autism with cognitive and verbal impairment, seizure disorder, and chronic constipation presented to the hospital with a one-day history of bright red blood per rectum. The patient’s mother reported a one-week history of constipation requiring over-the-counter laxative use at home. Initial vitals were noted for hypotension and tachycardia (BP of 96/67mmHg and pulse of 123 beats/minute). On abdominal examination, the patient had abdominal distension without guarding or tenderness; rectal examination showed hard stool mixed with bright red blood. Initial labs were significant for hemoglobin of 16.1g/dl, platelet count of 171, white blood cell count of 15.3, blood urea nitrogen of 14, serum creatinine of 1.46, and serum lactate of 6. A CT scan of the abdomen with intravenous and oral contrast showed a significant stool burden and diffuse small and large bowel dilatation suggestive of ileus. Manual dis-impaction was performed. Colonoscopy showed two abnormal erythematous, congested mucosa areas with linear ulceration in the descending colon suggestive of ischemic colitis. Biopsies of the ulceration showed hemorrhage with superficial erosion and ulceration consistent with ischemic colitis. The patient was discharged on a robust bowel regimen to prevent a recurrence. Discussion: SC complicated by ischemic colitis has a high mortality and morbidity rate. Physicians should have a high suspicion of this condition in patients with risk factors such as chronic constipation and immobility.Figure 1.: A-An arrow showing the area of ulceration in the descending colon. B- An arrow showing another area of ulceration in the descending colon C- Colon biopsy, H and E stain, 50x. The arrow is showing mucosal necrosis with mucosal hemorrhage, fibrin, and edema consistent with ischemic colitis.