Unusual etiology of lower digestive bleeding in a patient with constipation

Flores-Egocheaga L.E.; Puente De La Vega-Cáceres E.; Bellido-Caparó Á. · Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru (2025) · DOI: 10.47892/rgp.2025.451.1793

Resumen

The stercoral colitis is an inflammatory caused by fecal impactation. The etiology is poorly managed chronic constipation in specific risk groups. Patients usually present with abdominal pain, abdominal distension, and fever; in severe cases, peritoneal signs, shock or multiorgan failure may occur. It is important to have a high index of suspicion and request an abdominal CT scan with contrast. Treatment is conservative in the absence of peritoneal signs or hemodynamic instability; otherwise, management is surgical. We present the case of an 86-year-old male with a history of ischemic stroke, dysmobility and chronic constipation that presented with hematochezia. The imaging study showed thickening of the wall of the distal sigmoid colon and rectum, as well as feces inside. The endoscopic study revealed ulcers in the rectum and the recto-sigmoid junction. Conservative treatment with enemas and laxatives was indicated, with favorable clinical evolution.