eP207 From Obstruction to Resolution: A Case Series on Endoscopic Management in Stercoral Colitis

Aim To present two patients with faecal mass causing stercoral colitis (SC) and colonic obstruction managed endoscopically. Case presentations The first patient was a 71-year-old lady who presented with acute abdomen due to large bowel obstruction caused by an impacted faecal bolus in the distal transverse colon on CT, with features of SC. Due to significant comorbidities, a flexible sigmoidoscopy and disimpaction was performed. She re-presented with recurrent symptoms six months later, CT showed a similar picture and required another endoscopic disimpaction. She did not improve and a CT showed the faecal mass impacted in the sigmoid, which required a laparotomy. The second patient was a 69-year-old lady, who presented similarly, and a CT showed evidence of faecal mass causing obstruction in the sigmoid with evidence of SC. This was managed with flexible sigmoidoscopy and disimpaction. In both patients, sigmoidoscopy showed hard faecal mass causing obstruction, with evidence of mucosal ischaemia. The faecal mass was debulked and disimpacted with snare. Discussion Literature indicates SC is a potentially fatal condition with complications such as ischemic necrosis, perforation, and sepsis, with a mortality rate of up to 63% when severe complications arise. Most cases of SC are in the rectum and are managed by enemas or manual evacuation. SC higher up in the colon is more difficult to manage. We managed both patients endoscopically with good outcomes, although 1 patient re-presented with similar problems and required laparotomy. Conclusion Endoscopic disimpaction is feasible and safe in patients with SC proximal to the rectum.