ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Stercoral colitis is fecal impaction with pressure ischemia, ulceration, and possible perforation, and CT—not plain films—makes the diagnosis. Separately, end-of-life conversations in the ED depend less on time than on presence, plain language, and honest uncertainty.
Stercoral Colitis Recognition and Management
- Pressure ischemia mechanism: Stercoral colitis is an inflammatory colonic injury from impacted stool raising intraluminal pressure, with the rectosigmoid antimesenteric border especially vulnerable because of narrow lumen and watershed blood supply.
- High-risk patient profile: Think of it in older, immobile patients with chronic constipation or constipating medications such as opioids, antipsychotics, and calcium channel blockers, even when the complaint is just vague weakness or urinary symptoms.
- CT-based diagnostic anchor: CT abdomen and pelvis with IV contrast is the gold standard, with severe disease flagged by pneumoperitoneum, pneumatosis, extraluminal stool, or pericolonic abscess. We get into the imaging severity distinctions in the episode.
- Limited value of plain films: Abdominal radiographs do not reliably diagnose or exclude stercoral colitis; their main bedside role is looking for free air when the patient is too unstable for CT.
- ED treatment priorities: Initial management starts with digital disimpaction, then enemas and an oral bowel regimen, while avoiding opioids and correcting fluids and electrolytes rather than waiting for inpatient care.
- Early surgery and admission: Perforation carries mortality as high as 60%, which is why surgical consultation and inpatient admission are reasonable for essentially all confirmed cases, not just the obviously sick ones.
End-of-Life Conversations in the ED
- Presence over duration: A grounded 3 to 5 minute conversation often helps more than a longer detached one; sitting down at eye level and avoiding doorway updates changes how families experience the news.
- Plain language storytelling: Families process bad news better when you briefly tell the sequence of events in simple nonmedical terms—what happened before arrival, what was done, and what comes next or why it cannot.
- Honest uncertainty: Saying "I don't know" is often more trustworthy than speculation when prognosis or mechanism is unclear, especially after arrest or during rapidly evolving critical illness.
- Reducing inappropriate guilt: When families fixate on what they missed, a key move is to say plainly that they are not responsible and that some catastrophes are not predictable or preventable.
- Chaplains as team support: Chaplains extend care after death by staying with families, repeating information once shock sets in, and helping with rituals, viewing, and cultural needs while the ED keeps moving.
- Brief transition rituals: A five-minute pause before and after shift can create emotional containment for difficult cases and help separate resuscitation work from home life. We talk through what that looks like in the chapter.
Subscribe to ERcast: Clinical Perspectives to listen to the episode.
References:
- van Nispen C, Long B. High-risk and low incidence diseases: Stercoral colitis. Am J Emerg Med. 2025;90:151-156. PMID: 39874678
Faculty
- Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
- Brit Long, MD
Dr. Brit Long is a Professor of Emergency Medicine at the University of Virginia and an emergency medicine physician with experience in both a community ED and at a military academic center ED. He is the Clinical Editor-in-Chief of emDOCs.His professional interests include medical education, evidence-based medicine, and the FOAMed movement. Outside of work, he enjoys spending time with his wife and two daughters
- Tiffany Proffitt, DO
Dr. Proffitt is a board-certified Emergency Medicine physician practicing in Scottsdale, Arizona. She completed her medical training at Midwestern University Chicago College of Osteopathic Medicine and found her passion for medical education during her residency at Spectrum Health Lakeland. Tiffany is the co-founder and co-chairwoman of the HonorHealth Women Physicians Leadership Council, where she works to enhance professional development for 550 women clinicians. When she isn’t in the ED or podcasting, she’s chasing twins, dancing with toddlers, and enthusiastically singing the wrong lyrics to every song.
- Anne Steckowych, APRN
Emergency medicine is in Anne’s blood; her father has been an Emergency Medicine physician for the last 30 years. After earning her nursing degree from the University of New Hampshire (UNH) in 2018, Anne worked as an EMT at her local fire department, gaining practical experience that prepared her for five years as a nurse in the emergency department. She eventually returned to UNH to become an NP and has spent the last 8 years in the same ED, building relationships with a clinical team dedicated to providing the best possible patient care. Outside of the hospital, she’s usually skiing, hiking, or running in the New Hampshire hills. ERcast is her first podcast, and she’s thrilled to be part of the Hippo team.
- Brett Murray, MD
Dr. Murray is an Emergency Medicine physician practicing at a busy community trauma center. After attending Boston University School of Medicine, he completed his residency training at Brown University / Rhode Island Hospital, where he also served as Chief Resident from 2020 – 2021. His clinical interests center on medical education, performance science, and Emergency Medical Services.
- Deborah Mangan MA, Ordination, Certified Chaplain
