Stercoral Colitis as a Cause of Altered Mental Status in a Patient With Cerebral Palsy

Abstract

Stercoral colitis (SC) is a rare inflammatory colitis that occurs due to increased intraluminal pressure from impacted fecal content in the colon. Chronic constipation is the major risk factor for this condition. Delayed diagnosis is associated with high morbidity and mortality, with complications ranging from colonic perforation to intestinal ulcers. Patients usually present with non-specific symptoms, with advanced cases presenting with acute abdomen pain. This condition can be fatal if not recognized early and promptly treated. Early detection can often be difficult in elderly patients with dementia, stroke, or other neurologic disorders that cause altered mental status (AMS). Therefore, AMS in patients with severe constipation should be a substantial reason to consider stercoral colitis as a differential diagnosis. Here, we describe a case of stercoral colitis in a 59-year-old woman with non-verbal cerebral palsy who had acute metabolic encephalopathy from her stercoral colitis and was successfully treated with colonoscopic fecal disimpaction and an aggressive bowel regimen.