-
def
- constipated bedridden
- usually isolated rectosigmoid anitmesenteric
- ulcerating lesion less common sx hemorrhage
-
dx of stercoral perf
- round or ovoid
- > 1cm diameter antimesenteric
- fecalomas, fecalith protrudes through site of perf border necrotic
- microscopic pressure necrosis, ulcer, or chronic inflammatory rxn
- other path excluded
-
Rx
- resect
- simple closure and diversion-high mortality, disease segmental not focal
-
fecal impaction sequelae
- stercolar ulcer
- LBO
- perf in cecum
- gangrene and ischemia
- autonomic dysreflexia
- ptx from straining
- hypoxia
- hemorrhoids, rectal prolapse, volvulus
-
fecal impaction-rx
- manual disimpaction in OR, scissoring action to fragment stool, after removal high colonic irrigartion isotonic salt solutiion by large-bore catheter (standard cystoscopy irrigation), sigmoidoscopy
- laxatives
- large volume or retention enemas
- PIEE device
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