S5981 Stercoral Colitis Leading to Colonic Perforation in a Pediatric Patient: A Rare and Life-Threatening Condition

Introduction: Stercoral colitis is a rare and potentially fatal inflammatory condition of the colon caused by fecal impaction, most commonly affecting elderly, bed-bound, or neurologically impaired patients. The pathophysiology involves fecalomas exerting pressure on the colonic wall, leading to ischemia, ulceration, necrosis, and possible perforation. Timely diagnosis is critical, as complications may include peritonitis, sepsis, and death. Case Description/Methods: A 9-year-old male with autism, attention-deficit hyperactivity disorder, generalized anxiety disorder, and mild cerebral palsy presented with abdominal pain, vomiting, and 2 weeks of constipation, raising concerns for pyelonephritis and gastroenteritis. In the emergency department, he was tachycardic and exhibited marked leukocytosis and metabolic acidosis. He rapidly deteriorated, suffered cardiac arrest, and required resuscitation. Transferred to the pediatric intensive care unit, he displayed abdominal distention and required multiple pressors for blood pressure support. An abdominal computed tomography (CT) indicated significant colonic distention and stool burden, while KUB confirmed nonobstructive small bowel gas. The patient's abdomen became rigid and C-reactive protein (CRP) levels rose, leading to an exploratory laparotomy. Necrotic bowel was discovered, necessitating a subtotal colectomy. A subsequent laparotomy for washout and ileostomy formation was performed. The patient was started on a course of antibiotics due to increasing CRP levels. He was eventually discharged from the hospital after a 1-month stay. Discussion: Stercoral colitis is underrecognized in children but can occur in those with neurodevelopmental disorders and chronic constipation. Diagnosis relies on a high index of suspicion and imaging—CT with intravenous contrast is the gold standard. This case underscores the importance of early intervention, as delayed diagnosis can lead to catastrophic complications such as bowel necrosis and multi-organ failure. Management includes bowel decontamination, supportive care, and surgery in cases of perforation or ischemia. Serial abdominal exams and inflammatory markers (e.g., CRP) are essential for tracking disease progression. Pain management must avoid opioids, which reduce colonic motility. Conclusion: Stercoral colitis, though rare in pediatrics, should be considered in neurologically impaired children presenting with abdominal distension and constipation. Early recognition, imaging, and aggressive intervention are crucial to prevent life-threatening complications such as perforation and sepsis.