title: Stercolith perforation.
abstract: A 62-year-old diabetic bed ridden woman, presented to the emergency department with symptoms suggestive of peritonitis. She had been taking oral laxatives and enemas to relieve her chronic constipation for last 6 years. Hard impacted stools and pelvic tenderness were found on digital rectal examination. Her X-ray abdomen showed soft tissue shadows in the colon but there was no gas under the diaphragm on chest X-ray. Sonography found free fluid in pelvis. She was resuscitated, and her hyperglycemia was controlled by use of regular insulin as per sliding scale. Operative findings revealed free fluid in pelvis and very hard faecalomas lying free in peritoneal cavity. There was a 2 x 3 cm perforation at the anterior wall of the recto-sigmoid junction. Peritoneal toilet was carried out followed by Hartmann's procedure. Histopathology of perforation side showed no evidence of malignancy.
authors: Department of General Surgery, Combined Military Hospital, Rawalpindi, Pakistan. dramjidyasin@gmail.com
authors: Malik M Amjad
authors: MM
authors: Yasin
authors: Ghazala
authors: G
authors: Nasreen
authors: Farooq Azam
authors: FA
authors: Rathore
authors: Sikandar Ali
authors: SA
authors: Malik
mesh_terms: D003125:Colostomy; D003248:Constipation / Q000150:complications / Q000175:diagnosis; D005244:Fecal Impaction / Q000150:complications*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D007813:Laparotomy; D054368:Laxatives / Q000009:adverse effects; D008875:Middle Aged; D012810:Sigmoid Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D054368:Laxatives