A 48 y.o. complains of inability to urinate and lower abdominal pain

What is wrong?

Our patient had stercoral colitis.This is an inflammatory colitis caused by increased intraluminal pressure from impacted fecal material in the colon.  The rectosigmoid is the most frequently involved. The most important complication is perforation and mortality for the condition is 32-57%.

The condition is almost always found in cases of chronic constipation, advanced age and medical cormorbidities. Colonic wall thickening is > 3 mm, and air migrates from the colon lumen into the wall of the colon. In addition to constipation; diseases which cause obstruction of transit such as Hirschprung’s, hypercalcemia, and Chagas disease can cause stercoral colitis.

stercoral colitis causing perforation with free abd fluid, and discontinuity of the sigmoid in an opiod user

Our patient presented with abdominal distention and no urine output.  She was found to have urinary retention with a creatinine of 15  and a K of 5.0. She had bladder obstruction with hydronephrosis bilaterally.  A Foley was placed and 4L of urine was obtained. She was disimpacted at the bedside by general surgery. On the second day after disimpaction her Cr was 1.0 and she was discharged.

toxic megacolon occurs in 1% of patients with c diff as in this patient.

Unal E, Onur M, Baci S, et al. Stercoral colitis: diagnostic value of CT findings. 2017 Diagn Interv Radiol. Jan;23 (1):5-9.  

Serpell J, Nicholls R. Stercoral perforation of the colon Br J Surg 1990;77:1325-1329.

Core Topics in General and Emergency Surgery (6 ed.). Elsevier. 2019. Pp216-233.