Background Opioids are a common cause of constipation, which can lead to fecal impaction, colonic ulceration, necrosis, and perforation. Although uncommon, stercoral perforation is a serious complication and carries high rates of morbidity and mortality. Prompt surgical intervention is essential to optimize outcomes. Case Presentation We present a 33-year-old Caucasian female who was transferred for management of nausea, vomiting, and abdominal pain. She had a history of multiple abdominal surgeries and began using prescription opioids for pain management 10 years ago and began using IV heroin 7 years ago. She had recently completed several weeks of methadone inpatient rehabilitation and was in remission with suboxone therapy. On exam, she had tachycardia and significant abdominal tenderness. She had leukocytosis. The patient received medical management for ileus, abdominal pain, and anxiety with tap water enema, IV fluids, cefepime, metronidazole, lorazepam, phytonadione, acetaminophen, pantoprazole, ondansetron, quetiapine, calcium gluconate, and suboxone. A CT scan indicated perforation in the distal sigmoid colon with feculent peritonitis, and the patient was taken to the operating room for emergency laparotomy and required a total colectomy and end ileostomy. She was stabilized and discharged home and returned several weeks later for intraperitoneal drain placement. She did not have further associated complications. Conclusion Stercoral perforation is a rare but serious complication of chronic constipation. Patients with long-term opioid use have an increased risk for stercoral perforation, and there should be a low threshold for imaging and prompt intervention to avoid this life-threatening complication.

中文翻译：

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一例接受 suboxone 治疗的患者的胸骨穿孔

背景 阿片类药物是便秘的常见原因，可导致粪便嵌塞、结肠溃疡、坏死和穿孔。尽管不常见，但胸骨穿孔是一种严重的并发症，发病率和死亡率都很高。及时的手术干预对于优化结果至关重要。病例介绍 我们介绍了一名 33 岁的白人女性，她因恶心、呕吐和腹痛被转诊。她有多次腹部手术史，10 年前开始使用处方阿片类药物治疗疼痛，7 年前开始使用静脉注射海洛因。她最近完成了数周的美沙酮住院康复治疗，并且通过 suboxone 治疗获得缓解。检查时，她有心动过速和明显的腹部压痛。她有白细胞增多症。患者接受了治疗肠梗阻、腹痛和焦虑的药物治疗，包括自来水灌肠、静脉输液、头孢吡肟、甲硝唑、劳拉西泮、植物酮二酮、对乙酰氨基酚、泮托拉唑、昂丹司琼、喹硫平、葡萄糖酸钙和苏波酮。CT 扫描显示远端乙状结肠穿孔，伴恶液性腹膜炎，患者被送往手术室进行急诊剖腹手术，并需要进行全结肠切除术和回肠末端造口术。她病情稳定后出院回家，几周后返回进行腹腔引流。她没有进一步的相关并发症。结论 肠穿孔是慢性便秘的一种罕见但严重的并发症。长期使用阿片类药物的患者发生胸骨穿孔的风险增加，