International Journal of Clinical & Medical Images

Clinical Image:

A 68-year-old man with Parkinson’s disease presented to the Emergency Department with abdominal pain, diarrhea and anorexia. He had a chronic decline in mobility and was bedridden for one week prior to presentation. Physical examination revealed a non-tender mass extending from the left upper abdominal quadrant to the suprapubic area and caput medusae (Figure 1). Contrast-enhanced CT of the abdomen revealed a stercoroma with associated colitis (Figure 2). Treatment included non-narcotic analgesia, antibiotics, enemas, and manual disimpactions. Serial abdominal radiographs demonstrated improving stool burden. Symptoms resolved and he was discharged to an acute rehabilitation facility. Parkinson’s disease, like other medical conditions that cause constipation, can be complicated by the development of a stercoroma, which is an accumulation of inspissated feces that may appear as an abdominal tumor on physical examination. Large stercoromas can result in colonic distension and mural thickening. Perforation is a life-threatening complication with mortality rates approaching 50%.