Severe Stercoral Colitis Requiring Extensive Colectomy: A Report of Two Cases.

INTRODUCTION

Stercoral colitis caused by fecal impaction can lead to life-threatening ischemic injury of the colon. However, accurately assessing the severity and reversibility of ischemia remains challenging, particularly when determining the appropriate extent of surgical resection.

CASE PRESENTATION: We report 2 cases of stercoral colitis requiring emergency surgery. In both cases, CT demonstrated marked colonic dilatation due to fecal impaction, and intraoperative findings suggested diffuse colonic ischemia. Indocyanine green (ICG) fluorescence imaging revealed patchy hypoperfusion throughout the colon. Despite similar intraoperative findings, histopathological results differed: ischemic changes were limited to the mucosa in 1 case, whereas transmural necrosis was observed in the other. Both patients presented with severe systemic deterioration and were successfully treated with total colectomy followed by intensive postoperative management.

CONCLUSIONS

In severe stercoral colitis, the extent of histopathological ischemia does not necessarily correlate with clinical severity. Although ICG fluorescence imaging is useful for assessing bowel perfusion, it should not be used as the sole determinant of resection extent. Surgical decision-making should prioritize the overall clinical condition and the extent of colonic involvement, and extensive colectomy may be justified as a life-saving strategy in selected critically ill patients.