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Stercoral perforation of the colon in a heroin addict
  1. Cameron Douglas Brown1,
  2. Fraser Maxwell1,
  3. Paul French2,
  4. Gary Nicholson1,3
  1. 1Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, UK
  2. 2Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
  3. 3University of Glasgow, Glasgow, UK
  1. Correspondence to Cameron Douglas Brown, cameronbrown{at}


A 27-year-old female heroin addict presented with a peritonitic and distended abdomen. Her medical history included depression and a 3-year history of heroin abuse with attendant constipation. CT scan showed free intraperitoneal gas, massive faecal distension of the rectum and sigmoid colon and likely bowel necrosis. She underwent an emergency Hartmann's procedure for perforation of the sigmoid colon. Pathology identified two areas of stercoral ulceration, one of them being the area of perforation. Postoperatively, the patient developed a deep vein thrombosis and is now on anticoagulant therapy. She was discharged 4 weeks after admission. The patient has been reviewed at follow-up clinic by the surgical team and specialist stoma nurses. She is coping well with good stoma function. We will perform a colonoscopy to identify any further areas of stercoral ulceration but there are no plans for further surgery at present.

  • general surgery
  • drugs misuse (including addiction)
  • resuscitation

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  • Contributors CDB: project lead; completed write-up of case and coordinated between all coauthors for editing purposes. FM: advisor; gave advice regarding surgical intervention and preoperative work-up during case write-up. PF: contributor; gave pathology input with images and 'pathology' section of case report. GN: advisor and editor; edited all draft case reports and gave feedback throughout case write-up.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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