Stercoral perforation of the colon in a heroin addict

• Published in: BMJ case reports Vol. 2017; p. bcr-2016-218875
• Main Authors: Brown, Cameron Douglas, Maxwell, Fraser, French, Paul, Nicholson, Gary
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-08-2017; BMJ Publishing Group
• Series: Case Report
• Subjects: Abdomen; Adult; Advisors; Anticoagulants; Case reports; Colon; Colon, Sigmoid - diagnostic imaging; Colon, Sigmoid - surgery; Constipation; Family medical history; Fecal Impaction - diagnostic imaging; Fecal Impaction - surgery; Female; Gangrene; Heroin Dependence - complications; Humans; Intestinal Perforation - diagnostic imaging; Intestinal Perforation - surgery; Medical imaging; Metabolism; Mortality; Pain; Pathology; Peritonitis - etiology; Rare Disease; Tomography, X-Ray Computed; Treatment Outcome; United Kingdom; White; general surgery; resuscitation; drugs misuse (including addiction)
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-218875

A 27-year-old female heroin addict presented with a peritonitic and distended abdomen. Her medical history included depression and a 3-year history of heroin abuse with attendant constipation. CT scan showed free intraperitoneal gas, massive faecal distension of the rectum and sigmoid colon and likely bowel necrosis. She underwent an emergency Hartmann's procedure for perforation of the sigmoid colon. Pathology identified two areas of stercoral ulceration, one of them being the area of perforation. Postoperatively, the patient developed a deep vein thrombosis and is now on anticoagulant therapy. She was discharged 4 weeks after admission. The patient has been reviewed at follow-up clinic by the surgical team and specialist stoma nurses. She is coping well with good stoma function. We will perform a colonoscopy to identify any further areas of stercoral ulceration but there are no plans for further surgery at present.