SHM Converge Scientific Abstract ePoster Gallery-Constipation Catastrophe: A Case of Stercoral Colitis Resulting in Endocarditis

Pdf Summary

Stercoral colitis (SC) is an uncommon but serious inflammatory colitis caused by severe constipation and fecaloma formation, which can compromise blood flow to the colon and lead to ulceration, necrosis, perforation, peritonitis, septic shock, or death. Standard treatment includes manual disimpaction plus an aggressive bowel regimen, which must continue after disimpaction to prevent recurrence. SC is most often seen in elderly, institutionalized, or neurologically impaired patients, as well as those with chronic opioid use or psychiatric illness.<br /><br />This case describes a 66-year-old man with ESRD on hemodialysis, chronic constipation, and prior SC complicated by enterococcal bacteremia. He presented with two weeks of fever and weakness. Workup showed gram-positive cocci in chains in blood cultures, a new aortic regurgitation murmur, and transthoracic/transesophageal echocardiography confirming aortic valve vegetation, consistent with infective endocarditis. Enterococcus faecalis was isolated from blood and pleural fluid. CT abdomen identified stercoral colitis, supporting it as the likely source of recurrent bacteremia.<br /><br />The patient was initially treated with ceftriaxone and vancomycin, then switched to ampicillin and ceftriaxone after Infectious Disease consultation. Because bacteremia persisted, he was started on an aggressive bowel regimen for source control and antibiotics were adjusted to gentamicin, after which the bacteremia cleared. He did not require valve surgery and was discharged on six weeks of gentamicin and vancomycin with ongoing hemodialysis and an intensified bowel regimen.<br /><br />The report highlights a rare but important complication of stercoral colitis: bacteremia leading to endocarditis. It emphasizes the need for prompt recognition of chronic constipation complications, effective source control, and clear outpatient bowel regimen instructions to prevent recurrence.

Asset Subtitle

Rita A. Bedrossian

Meta Tag

Author List Joshua Smith, Kevin Yu, Rita A. Bedrossian

Category Clinical Vignettes

Concept Stercoral Colitis

Concept Constipation

Concept Fecaloma

Concept Manual Disimpaction

Concept Perforation

Distinguished Non-Finalist

Presenter Organization Los Angeles General Medical Center

Presenting Author Rita A. Bedrossian

Track Adult

Keywords

stercoral colitis

fecaloma

chronic constipation

enterococcus faecalis

bacteremia

infective endocarditis

aortic valve vegetation

hemodialysis

source control

bowel regimen

Stercoral Colitis

Constipation

Fecaloma

Manual Disimpaction

Perforation