Not All Turds are Created Equal. CC: Abdominal Pain HPI: 25 y old female. Presents with one day of progressive abdominal pain. Generallized, progressive.

Not All Turds are Created Equal

Not All Turds are Created Equal

CC: Abdominal Pain HPI: 25 y old female. Presents with one day of

progressive abdominal pain. Generallized, progressive and constant pain. Sudden worsening of pain 2 hours ago. Associated nausea and vomiting. No fever. Bloating. Flatus.

LBM in am (“normal”) History of same problem one

month ago. Admitted to ERH. After Xrays and CT scan was given two bottles of Go-Lytley and discharged the following day.

Not All Turds are Created Equal

PMH:◦ Anorexia-bulemia◦ AKA due to severe

osteopenia and # non-union

◦ Prescription narcotic dependence

◦ Chronic constipation

Not All Turds are Created Equal

Physical Exam: HR-120 BP-120/60

RR-18 T -36.7 Marked discomfort Chest: clear CVS: normal Abdomen:

Protruberant, BS+, generallized tenderness, guarding and reboundlarge right periumbilical mass (mobile)

Not All Turds are Created Equal

Xray

Not All Turds are Created Equal

One month prior

Not All Turds are Created Equal

Not All Turds are Created Equal

XrayCT

Not All Turds are Created Equal

Not All Turds are Created Equal

XrayCTTreatment??

Stercoral PerforationDefinition:

“perforation of the large bowel due to pressure necrosis from a fecal mass”

Stercoral PerforationIncidence: 100

reported casesAge: 4y-85y

(mean=59y)Mortality: 35%History of

constipation: 60%Risk factors:

◦ NSAIDs, Antacids, Steroids, Narcotics

◦ Neurologically impaired patients

Stercoral PerforationDiagnostic Criteria

◦ Ovoid colonic perforation (antimesenteric)

◦ Fecalomas (within bowel or intraperitoneal)

◦ Pressure necrosis at perforation site

May be multiple sites of erosion/perforation

(27% of cases)

Stercoral PerforationSites:

◦ Sigmoid (47%)◦ Rectum (30%)◦ Caecum (9%)◦ Transverse (7%)◦ Descending (5%)