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Age: 52

Sex: Female

Indication: Generalized abdominal pain

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Case #11


Findings

  • Lower chest
    • Markedly distended lower thoracic esophagus filled with fluid and gas
    • Moderate-sized hiatal hernia
    • Patchy bilateral lower lobe groundglass opacities and dependent consolidation, right greater than left
  • Abdomen/Pelvis
    • Massive rectal distension measuring up to 11 cm in diameter with a large volume of formed stool in the rectum
    • Distal sigmoid colon and rectal wall thickening and surrounding fat stranding
    • Diffuse colonic distension with a moderate colonic stool burden
    • Stomach is moderately distended with fluid
    • Circumferential mural thickening of the urinary bladder and urothelial thickening and enhancement of both ureters
    • Bladder is decompressed around a Foley catheter and is ventrally displaced and flattened by the massively distended rectum
    • Scattered subcentimeter hepatic and bilateral renal hypodensities, which are too small to characterize
    • Small volume free fluid layering in the anatomic pelvis
  • MSK
    • No acute findings


Diagnosis

  • Stercoral proctocolitis

Sample Report

Massive distension of the rectum and sigmoid colon with findings concerning for fecal impaction and stercoral proctocolitis. No evidence of perforation, abscess, or ischemia.

Markedly distended lower thoracic esophagus with a moderate-sized hiatal hernia. Consider nonemergent esophagram or upper endoscopy for further evaluation. These findings place the patient at risk for aspiration.

Dependent airspace disease in both lower lobes concerning for pneumonia or aspiration pneumonitis.

Circumferential bladder wall thickening and urothelial thickening of both ureters may relate to urinary tract infection. Recommend correlation with urinalysis.


Discussion

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Images

Stercoral proctocolitis: massively distended rectum with impacted stool, wall thickening, and surrounding mesorectal fat stranding (red arrows) resulting in ventral displacement and flattening of the urinary bladder (yellow arrow identifies the Foley catheter retention balloon).



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