A 90-year-old woman with Parkinson’s disease presented with acute abdominal pain, nausea, and coffee-ground emesis. Her abdomen was distended with diffuse tenderness and hypoactive bowel sounds. Computed tomography (CT) showed a distended rectum with stool measuring up to 9 cm (Fig. 1A) and pneumatosis in the posterior gastric wall and air within the portal venous structures (Fig. 1B). She was diagnosed with probable stercoral colitis based on a history of chronic constipation and evidence of fecal impaction in the rectosigmoid and dilation of the colon in the CT scan, causing ischemic gastritis. Given hemodynamic stability, she was managed non-surgically with enemas, antibiotics, and a nasogastric tube and discharged home with hospice.
Fig. 1.
A Computed tomography (CT) of the abdomen, demonstrating a distended rectum with stool measuring up to 9 cm (asterisk). B Pneumatosis of the posterior gastric fundal wall (white arrow) and air within the portal venous structures (black arrow), suggestive of ischemic gastritis
Ischemic gastritis is a rare but rapidly life-threatening diagnosis in the elderly1 that can present with nausea, vomiting, upper gastrointestinal bleeding, and distention.2 Diagnosis is made primarily by the presence of extraluminal gas in the portal venous system and pneumatosis of the gastric wall. Management is usually conservative, with antibiotics, proton-pump inhibitors, and parenteral nutrition, though surgical resection may be considered in severe cases.2 This case illustrates that chronic constipation, slowed gastrointestinal motility, and chronic gastric distention from Parkinson’s disease are potential risk factors for stercoral colitis and, if progressive, ischemic gastritis. 1,3–5
Author Contribution
SEA and EPT took care of the patient. SEA wrote the first draft of the manuscript. EPT and CS revised and edited the draft. All of the authors commented on the manuscript and approved the final version.
Consent for Publication
Consent for publication was received from the patient’s family.
Conflict of Interest
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
REFERENCES
- 1.Heffernan C, Pachter HL, Megibow AJ, Macari M. Stercoral colitis leading to fatal peritonitis: CT findings. AJR Am J Roentgenol. 2005;184(4):1189–1193. doi: 10.2214/ajr.184.4.01841189. [DOI] [PubMed] [Google Scholar]
- 2.Tang S-J, Daram SR, Wu R, Bhaijee F. Pathogenesis, diagnosis, and management of gastric ischemia. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2014;12(2):246–252.e1. doi: 10.1016/j.cgh.2013.07.025. [DOI] [PubMed] [Google Scholar]
- 3.Morano C, Sharman T. Stercoral Colitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Sep 17]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560608/.
- 4.Naseer M, Gandhi J, Chams N, Kulairi Z. Stercoral colitis complicated with ischemic colitis: a double-edge sword. BMC Gastroenterol. 2017;17(1):129. doi: 10.1186/s12876-017-0686-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Powell JL, Payne J, Meyer CL, Moncla PR. Gastric necrosis associated with acute gastric dilatation and small bowel obstruction. Gynecol Oncol. 2003;90(1):200–203. doi: 10.1016/S0090-8258(03)00204-X. [DOI] [PubMed] [Google Scholar]