Stercoral Ulcer Presenting in a Patient with Cauda Equina Syndrome Secondary to Postoperative Epidural Hematoma

Medicina, 2023 · DOI: 10.3390/medicina59071331 · Published: July 19, 2023

Spinal Cord Injury Surgery Gastroenterology

Simple Explanation

Chronic constipation can lead to fecal impaction in the large bowel, which can cause pressure necrosis followed by perforation, known as a stercoral ulcer. Extensive spinal surgeries, prolonged operation time, significant blood loss, perioperative narcotic use, and spinal cord injury might contribute to the development of stercoral ulcers. This paper highlights the importance of recognizing the potential development of stercoral ulcers in patients with CES and emphasizes the need for prompt diagnosis and management to avert catastrophic complications.

Study Duration

1 Year

Participants

One 77-year-old woman

Evidence Level

Case Report

Key Findings

1
A 77-year-old woman with CES developed a stercoral ulcer in the sigmoid colon after undergoing extensive posterior lumbar interbody fusion.
2
The patient presented with severe hematochezia and hypovolemic shock, requiring urgent colonoscopy and intensive care.
3
Possible factors contributing to the stercoral ulcer included advanced age, extensive spinal surgery, prolonged operation time, significant blood loss, narcotic use, and CES.

Research Summary

This case report describes a 77-year-old woman with cauda equina syndrome (CES) who developed a stercoral ulcer after undergoing extensive spinal fusion surgery. The patient's condition was complicated by factors such as chronic constipation, prolonged surgery, significant blood loss, and perioperative narcotic use, all of which contributed to fecal impaction and subsequent ulceration. The report emphasizes the importance of recognizing the risk of stercoral ulcers in patients with CES undergoing spinal surgery and highlights the need for prompt diagnosis and management to prevent potentially life-threatening complications.

Practical Implications

Clinical Awareness

Increased awareness among clinicians about the potential for stercoral ulcers in patients with CES, especially after spinal surgery.

Risk Factor Management

Proactive management of risk factors such as chronic constipation, narcotic use, and prolonged immobilization in susceptible patients.

Early Diagnosis and Intervention

Prompt diagnosis through colonoscopy and timely intervention to prevent severe complications like perforation and bleeding.

Study Limitations

1
Single case report limits generalizability.
2
Establishing direct causal relationship between pain medication and stercoral ulcer is difficult.
3
Determining the precise pathophysiology of this patient poses challenges.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury