An extremely rare case of stercoral colitis with a subsequent benign stricture: preoperative thin endoscopic assessment to optimize surgical extent.

Stercoral obstructive colitis is a rare but potentially life-threatening condition that often progresses to septic shock or colonic necrosis. Optimal management strategies, balancing conservative stabilization with surgical timing and extent, remain unclear. We present the case of an 81-year-old man who presented with obstipation, abdominal pain, hematochezia, and shock (blood pressure: 74/59 mmHg, lactate level: 8.1 mmol/L). Computed tomography showed diffuse fecal loading without signs of necrosis or perforation. Aggressive conservative therapy (manual disimpaction, fluids, and antibiotics) achieved stabilization. During recovery, a 30 cm benign stricture developed from the left transverse colon to the rectosigmoid colon. This is the first documented case in which thin endoscopic mapping was used to traverse the stenotic segment, delineate ulcer-scar changes, and tattoo healthy mucosa, enabling limited left hemicolectomy with primary anastomosis and stoma avoidance. Histological examination revealed severe submucosal fibrosis with chronic inflammatory cell and eosinophil infiltration, indicating reparative phase changes. Therefore, thin endoscopic assessment after stabilization can optimize surgical planning and reduce invasive management in patients with stercoral obstructive colitis and postinflammatory strictures.