AB145. SOH23ABS_157. Recurring stercoral perforation in a patient with ehlers-danlos syndrome, type 4
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AB145. SOH23ABS_157. Recurring stercoral perforation in a patient with ehlers-danlos syndrome, type 4

Steve Okwu1, James Murphy1,2, Aidan Manning1,2

1Department of Surgery, University Hospital Waterford, Waterford, Ireland; 2Department of Breast Surgery, University Hospital Waterford, Waterford, Ireland

Background: Stercoral perforation is a rare cause of colonic perforation, typically occurring in the setting of chronic constipation in elderly patients. Mortality rates are estimated at approximately 35%, but these can be improved with early detection and prompt surgical management. Certain genetic conditions may also predispose to stercoral perforation in younger patient groups.

Methods: We present the case of a 27-year-old female who presented with an acute abdomen. An emergency laparotomy and Hartmann’s procedure was performed for a stercoral perforation of the sigmoid colon. This patient was readmitted 10 days post-discharge with recurrence of acute abdominal pain and a repeat CT showed colitis of the descending colon. This was managed conservatively. This patient was readmitted acutely 6 weeks later for the third time. Laparotomy revealed a recurrent sigmoid stercoral perforation proximal to the sigmoid colostomy. A further sigmoid resection was performed with refashioning of the end colostomy.

Results: In view of this patient’s young age and atypical risk-factor profile for stercoral perforation, genetic testing was performed to assess for an underlying connective tissue disorder. A heterozygous pathogenic variant of COL3A1 was identified, consistent with a diagnosis of Vascular Ehlers-Danlos Syndrome (EDS type 4). This syndrome is associated with increased risk of vascular dissection or rupture, gastrointestinal perforation and uterine rupture.

Conclusions: Stercoral perforation is rare and is associated with a high mortality rate. Early diagnosis and emergency surgery is essential. An underlying connective tissue disorder such as Ehlers-Danlos Syndrome type 4 should be considered in younger patients presenting with recurring stercoral perforation.

Keywords: Constipation; faecaloma; faecal impaction; stercoral perforation; stercoral ulcers


Funding: None.


Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-23-ab145
Cite this abstract as: Okwu S, Murphy J, Manning A. AB145. SOH23ABS_157. Recurring stercoral perforation in a patient with ehlers-danlos syndrome, type 4. Mesentery Peritoneum 2023;7:AB145.

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