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- W2914459568 abstract "Stercoral perforation of the colon is a rare disease. It has been defined as “perforation of the bowel due to pressure necrosis from fecal masses, also referred as fecalomas” (1). Botezomib is a Proteasome inhibitor used in the treatment of Multiple Myeloma. This is an interesting presentation of Stercoral perforation in the setting of a patient suffering from chronic constipation undergoing treatment with Bortezomib and Dexamethasone. A 53-year-old female with chronic constipation, Multiple Myeloma recently started on Bortezomib and Dexamethasone presented to the hospital with sudden onset abdominal pain and fever. Physical examination revealed patient to be lethargic, febrile and tachycardic. Abdominal exam revealed signs of acute peritonitis. Abdominal CT showed an inflammatory mass in the pelvis, pneumoperitoneum and suspected perforation of the sigmoid colon (Figure 1). Patient was emergently taken for exploratory laparotomy. Upon opening incision, there was diffuse fecal peritonitis. The bowel was noted to have an approximate 5 cm perforation in the sigmoid colon secondary to an ovoid ulcer with multiple hard stools (Figure2). Patient then underwent a sigmoid colectomy and an end-colostomy (Hartmann's procedure). Pathology revealed acute inflammation involving full thickness of the wall and extensive acute serositis (Figure 3). CMV and GMS stains negative. Postoperative course was uneventful. Stercoral ulceration is a life threatening and a rare complication of chronic constipation. Stercoral ulcers are the result of hardened stools (fecalomas) that produce increased intraluminal pressure on the colon resulting in bowel ischemia. Over time, this increased pressure can result in gastrointestinal bleeding, necrosis, and perforation, usually located in the anti-mesenteric border of the descending colon, where the bowel wall has the lowest blood supply and narrowest diameter (2). Although it has been postulated that Bortezomib may result in paralytic ileus (3), the exact mechanism is unknown. This stresses importance of maintaining a proper bowel regimen to ensure bowel movements for patients with chronic constipation, especially the ones who are going to need Bortezomib.Figure: Perforation of the Sigmoid Colon.Figure: Gross Specimen of the Sigmoid Colon.Figure: Acute Serositis of Sigmoid Colon." @default.
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- W2914459568 date "2017-10-01" @default.
- W2914459568 modified "2023-09-27" @default.
- W2914459568 title "Stercoral Perforation of the Sigmoid Colon in a Patient Treated With Bortezomib Chemotherapy" @default.
- W2914459568 doi "https://doi.org/10.14309/00000434-201710001-01471" @default.
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