{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:06:24Z","timestamp":1764785184687,"version":"build-2065373602"},"reference-count":15,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Chronic constipation can lead to fecal impaction in the large bowel, which can cause pressure necrosis followed by perforation, known as a stercoral ulcer. In extensive posterior thoracolumbar surgery, a long operation time, large blood loss, and perioperative narcotic use may aggravate constipation. Moreover, sacral root palsy due to cauda equina syndrome (CES) can lead to the deterioration of fecal impaction. This report describes the case of a 77-year-old woman with CES who presented with saddle anesthesia, neurogenic bladder, bowel incontinence, and paraplegia. Five days prior, she had undergone extended posterior lumbar interbody fusion from L1 to L5. Lumbar magnetic resonance imaging (MRI) showed an extended epidural hematoma. After urgent neural decompression, she gradually recovered from the saddle anesthesia, leg pain, and paraplegia over 3 weeks. Thereafter, the patient suddenly developed massive hematochezia and hemorrhagic shock. Urgent colonoscopy was performed, and a stercoral ulcer in the sigmoid colon was diagnosed. After 4 weeks of intensive care for hemorrhagic shock, pneumonia, and systemic sepsis, the patient was transferred to a general ward for intensive rehabilitation. One year after the operation, she was able to walk with assistance, and her urinary and bowel incontinence completely recovered. Chronic constipation, a common clinical problem, can sometimes cause relatively obscure but potentially life-threatening complications such as stercoral ulceration. Possible factors including advanced age, extensive spinal surgeries, prolonged operation time, significant blood loss, perioperative narcotic use, and the presence of spinal cord injury might contribute to the development of this condition. It highlights the importance of recognizing the potential development of stercoral ulcers in patients with CES and emphasizes the need for prompt diagnosis and management to avert catastrophic complications.<\/jats:p>","DOI":"10.3390\/medicina59071331","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T21:20:14Z","timestamp":1689801614000},"page":"1331","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Stercoral Ulcer Presenting in a Patient with Cauda Equina Syndrome Secondary to Postoperative Epidural Hematoma"],"prefix":"10.3390","volume":"59","author":[{"given":"Min-Seok","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9189-6639","authenticated-orcid":false,"given":"In-Seok","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Jeju National University Hospital, Jeju 63241, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suk-Ha","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2283-1687","authenticated-orcid":false,"given":"Tae-Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1945-1474.1993.tb00671.x","article-title":"Managing quality on an orthopedic service: Ileus in the lumbar spinal fusion patient","volume":"15","author":"Benacker","year":"1993","journal-title":"J. Healthc. Qual."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1097\/00024720-200312000-00003","article-title":"Perioperative complications of threaded cylindrical lumbar interbody fusion devices: Anterior versus posterior approach","volume":"16","author":"Scaduto","year":"2003","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S1052-5157(18)30302-7","article-title":"Colonoscopy and acute colonic pseudo-obstruction","volume":"7","author":"Rex","year":"1997","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.clineuro.2014.08.036","article-title":"Constipation after thoraco-lumbar fusion surgery","volume":"126","author":"Stienen","year":"2014","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1038\/sj.sc.3101066","article-title":"Gastrointestinal and segmental colonic transit times in patients with acute and chronic spinal cord lesions","volume":"38","author":"Krogh","year":"2000","journal-title":"Spinal Cord"},{"key":"ref_6","first-page":"8881840","article-title":"Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury","volume":"2020","author":"Basnayake","year":"2020","journal-title":"Case Rep. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1136\/bmj.300.6738.1494","article-title":"Control of defecation in patients with spinal injuries by stimulation of sacral anterior nerve roots","volume":"300","author":"MacDonagh","year":"1990","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1001\/jama.1959.03010320031008","article-title":"Stercoraceous ulcers of the colon: Relatively neglected medical and surgical problem","volume":"171","author":"Grinvalsky","year":"1959","journal-title":"J. Am. Med. Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2615","DOI":"10.3748\/wjg.14.2615","article-title":"Lower gastrointestinal bleeding: Association with Sevelamer use","volume":"14","author":"Madan","year":"2008","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/BF02237366","article-title":"Use of accurate diagnostic criteria may increase incidence of stercoral perforation of the colon","volume":"43","author":"Maurer","year":"2000","journal-title":"Dis. Colon. Rectum"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/S0002-9270(00)00718-8","article-title":"Functional bowel disorders in the geriatric patient: Constipation, fecal impaction, and fecal incontinence","volume":"95","author":"Rose","year":"2000","journal-title":"Am. J. Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.bpg.2009.09.001","article-title":"Constipation in old age","volume":"23","author":"Gallagher","year":"2009","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.jos.2017.04.006","article-title":"Bowel\/bladder dysfunction and numbness in the sole of the both feet in lumbar spinal stenosis\u2013A multicenter cross-sectional study","volume":"22","author":"Watanabe","year":"2017","journal-title":"J. Orthop. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.3349\/ymj.2015.56.6.1627","article-title":"Paralytic Ileus and Prophylactic Gastrointestinal Motility Medication after Spinal Operation","volume":"56","author":"Oh","year":"2015","journal-title":"Yonsei Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1111\/codi.12123","article-title":"A systematic review of stercoral perforation","volume":"15","author":"Chakravartty","year":"2013","journal-title":"Colorectal Dis."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1331\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:14:52Z","timestamp":1760127292000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":15,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["medicina59071331"],"URL":"https:\/\/doi.org\/10.3390\/medicina59071331","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2023,7,19]]}}}