Stercoral Ulcer-related Lower Rectal Perforation Associated with Persistent Rectal Fecal Impaction: Three Case Reports and Clinical Implications.

Stercoral ulcer-related lower rectal perforation is an uncommon but potentially under-recognized condition. We report three cases of elderly women with localized lower rectal perforation associated with persistent rectal fecal impaction. All patients presented with hematochezia without generalized peritonitis despite the continued passage of loose or muddy stools. Serial computed tomography revealed persistent fecal impaction in the lower rectum during the clinical course. Continued bowel movement does not necessarily indicate effective rectal evacuation. Recognition of persistent rectal fecal impaction may facilitate an earlier diagnosis and appropriate management.