Prognostic Factors Associated With Treatment Failure in Uncomplicated Stercoral Colitis at an Emergency Department: A Retrospective Cohort Study

TL;DR

This study identifies factors that predict treatment failure in patients with uncomplicated stercoral colitis, helping doctors identify high-risk patients early.

Contribution

The study identifies specific clinical and imaging factors associated with treatment failure in uncomplicated stercoral colitis patients.

Findings

Rebound tenderness, pneumatosis coli, and free fluid on CT scans are strongly associated with treatment failure.

Frailty and blood test results like serum amylase and D-dimer were not linked to poor outcomes.

13% of patients with uncomplicated stercoral colitis experienced treatment failure.

Abstract

Background: Stercoral colitis (SC) can potentially lead to bowel ischemia, sepsis, and perforation. While physicians have increasingly recognized the clinical importance of this condition, the risk of progression in patients with uncomplicated SC who do not have indications for emergency surgery remains unclear. The aim of this study was to determine prognostic factors associated with treatment failure in patients with uncomplicated SC in an emergency care setting.

Methods: We conducted a retrospective cohort study at a tertiary care hospital from April 2013 to March 2023. We included patients aged 18 years or older who were diagnosed with uncomplicated SC based on computed tomography (CT) at the emergency department. We analyzed the following prognostic factors: age, frailty, rebound tenderness, serum amylase level, and D-dimer level. We also analyzed the following CT findings: location of impacted fecaloma, maximum axial diameter and thickening of the affected colon, and the presence of pneumatosis coli and free fluid. The primary outcome was treatment failure, defined as the need for conversion from conservative treatment to emergency surgery or progression to in-hospital death. We used univariate logistic regression analysis to estimate odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Of the 117 patients identified, 15 patients (13%) had treatment failure. The presence of rebound tenderness (crude OR 57, 95% CI 10-330) and CT findings of pneumatosis coli (crude OR 4.7, 95% CI 1.5-14) and free fluid (crude OR 6.5, 95% CI 2.0-21) were associated with treatment failure. Frailty and results of blood examinations were not associated with poor outcomes.

Conclusion: A substantial number of patients with uncomplicated SC progressed to requiring emergency surgery or died. Physical signs of peritonitis and specific CT findings may aid in the identification of high-risk patients who require closer monitoring and potential surgical intervention.

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