Necrotic stercoral colitis: importance of computed tomography findings.
OBJECTIVE
To study the computed tomography (CT) signs in facilitating early diagnosis of necrotic stercoral colitis (NSC).


METHODS
Ten patients with surgically and pathologically confirmed NSC were recruited from the Clinico-Pathologic-Radiologic conference at Chang Gung Memorial Hospital, Taoyuan, Taiwan. Their CT images and medical records were reviewed retrospectively to correlate CT findings with clinical presentation.


RESULTS
All these ten elderly patients with a mean age of 77.1 years presented with acute abdomen at our Emergency Room. Nine of them were with systemic medical disease and 8 with chronic constipation. Seven were with leukocytosis, two with low-grade fever, two with peritoneal sign, and three with hypotensive shock. Only one patient was with radiographic detected abnormal gas. Except the crux of fecal impaction, the frequency of the CT signs of NSC were, proximal colon dilatation (20%), colon wall thickening (60%), dense mucosa (62.5%), mucosal sloughing (10%), perfusion defect (70%), pericolonic stranding (80%), abnormal gas (50%) with pneumo-mesocolon (40%) in them, pericolonic abscess (20%). The most sensitive signs in decreasing order were pericolonic stranding, perfusion defect, dense mucosal, detecting about 80%, 70%, and 62.5% of the cases, respectively.


CONCLUSIONS
Awareness of NSC and familiarity with the CT diagnostic signs enable the differential diagnosis between NSC and benign stool impaction.
Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, 333 Taoyuan, Taiwan, China.
Cheng-Hsien
CH
Wu
Li-Jen
LJ
Wang
Yon-Cheong
YC
Wong
Chen-Chih
CC
Huang
Chien-Cheng
CC
Chen
Chao-Jan
CJ
Wang
Jen-Feng
JF
Fang
Chuen
C
Hsueh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003092:Colitis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology*; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005244:Fecal Impaction / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
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