CASE REPORTS   

Chirurgia 2014 February;27(1):51-3

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Severe constipation and rectal spontaneous perforation in elderly: case report and review of the literature

Grasso E. ¹, Politi A. ², Progno V. ², Guastella T. ²

¹ Department General Surgery Clinic “Santa Maria”, Bari, Italy; ² Department of Emergency Surgery and PS University of Catania, Hospital “Cannizzaro”, Catania, Italy

Although severe constipation represents a common problem in the elderly it is not considered as a potential cause of major complication. Faecal impaction in a severe constipation condition may lead to serious complications including stercoral perforation.
A 90-year-old white female presented to the Emergency Room with increasing crampy pain in the left lower abdominal quadrant over a 10 days period with tenesmus. The study showed in the retroperitoneal space along the left kidney and in pre sacral area fecal material. The retroperitoneal space filled by feces and air was opened along the sigmoid and rectum: a large perforation of the extraperitoneal rectum with a faecaloma imbedded was found. The histological diagnosis of multiple stercoral ulcer with rectal perforation was made. Although perforation of the colon is a well known event as a complication of diseases such as carcinoma, colitis, ruptured diverticulitis, intestinal occlusion or trauma, stercoral perforation of the colon (SPC) is rare. This case illustrates that severe chronic constipation requires adequate management and aggressive medical treatment.