Stercoral perforation of the colon

[Extract] We read with interest the review by Messrs Serpell and Nicholls on stercoral perforation of the colon (Br J Surg 1990; 77:1325-9) having recently managed two such cases, both of whom reperforated after limited colonic resection with exteriorization. he paramount impression we have gained from these cases is that, while the initial operation coped with the perforation, it failed singularly to address the aetiology of that perforation, and we question whether these patients may have been better served by undertaking total colectomy and ilcostomy, preserving the rectal stump for later ileorectal anastomosis. Such a strategy would negate the risk of further early stercoral perforation, as experienced both by ourselves and the authors, and also address the problem of chronic constipation that has already resulted in a life-threatening complication.