Overview: The authors present the case of
an elderly, nonverbal nursing home resident
with dementia who developed fecal impaction,
despite interventions such as enema. Subsequent
stercoral perforation of the sigmoid colon
resulted in peritonitis, sepsis, and death. The
authors discuss colon perforation as a result
of fecal impaction, as well as the difficulties of
pain assessment and communication in patients
with dementia.