Bicolor stools

Specialty: Gastrointestinal.

• Double colored stools
• segmented stools in color
• stools with mixed tone

Why it occurs

• Intermittent or incomplete biliary obstruction (floating choledocholithiasis or ampullary neoplasia in initial stages that ulcerates and allows partial passage of bile alternating with periods of acholia)
• Accelerated segmental intestinal transit disorder with incomplete digestion and absorption of bile pigments in part of the fecal bolus
• Concomitant consumption of oral iron or bismuth supplements with incomplete evacuation of previous fecal remains.

Initial workup

Upper abdominal ultrasound (to evaluate cholelithiasis, choledocholithiasis or bile duct dilation) | Magnetic resonance cholangioresonance (MRCP) to obtain an accurate map of the intra- and extrahepatic bile duct | Complete liver analysis (bilirubin, FA, GGT, transaminases).

Standard management

• Symptomatic treatment and support depending on the cause of biliary obstruction
• Broad-spectrum intravenous antibiotic therapy in case of associated cholangitis
• Temporary suspension of iron or bismuth supplements to assess whether the homogeneous color of the stool is normalized.