Abstract Introduction Stercoral proctitis is a condition caused by fecal impaction in the distal colon or rectum that leads to inflammation of the rectal wall under sustained pressure. It arises when the hardened stool exerts elevated intraluminal pressure, resulting in localized ischemia, mucosal ulceration and inflammation. In rare cases, persistent pressure and ischemia from fecal impaction can cause transmural necrosis of the rectal wall, allowing bacteria and toxins to translocate into the bloodstream, triggering sepsis. Case Report A 73-year-old female with a past medical history of hypertension, hypothyroidism and small bowel obstruction presents to the hospital for abdominal pain, nausea, and vomiting. Upon arrival, Patient was showing signs of respiratory distress requiring Bilevel Positive Airway Pressure (BiPAP) and then eventually mechanical ventilation. Vitals were significant for tachypnea and tachycardia, and labs showed leukocytosis and lactic acidosis. She was initially administered sepsis fluid bolus of 30cc/kg. She also had a computed tomography (CT) scan of the thorax and abdomen and pelvis which demonstrated a large colonic and rectal stool burden with pericolonic inflammatory changes extending from the splenic flexure to the rectum, possibly related to a stercoral colitis. When orogastric tube was placed, moderate amount of stool was expelled while on low continuous suction. Arterial line was placed and showed lower pressures. She was started on levophed, vasopressin and phenylephrine via central line. Blood and stool cultures were collected, and she was started on empiric vancomycin, zosyn and micafungin. Surgery recommended conservative management with aggressive bowel regimen with no surgical interventions. Infectious disease recommended continuing with meropenem, alluding the septic shock to intra-abdominal process. Through the course of hospitalization with bowel regimen and antibiotic administration, she started having adequate bowel movements and her pressor requirements came down. Her stool and blood cultures were negative, but she completed a seven day antibiotic course. She was successfully extubated and downgraded from the unit. Discussion Studies have shown that stercoral proctitis typically causes septic shock in 0.5-2% of cases in the setting of perforation or peritonitis. This case illustrates a challenging phenomenon as this patient never had a perforation but nonetheless was in multi-pressor septic shock. She was also at high risk of stercoral ulcers, perforation, and ischemic colitis with mortality rates up to 32-60%. This case proves that early diagnosis and aggressive management—encompassing bowel decompression, fluid resuscitation, broad-spectrum antibiotics, and supportive care are crucial to prevent any further complications. This abstract is funded by: None
Shah et al. (Fri,) studied this question.