An 82-Year-Old Woman With Abdominal Pain

James J. McCombie, MB ChB

Disclosures

March 13, 2017

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

An 82-year-old woman presents to the emergency department from a nursing home. She had been visited by her general practitioner because she was experiencing abdominal pain. Because the patient has dementia, the history is limited and is provided by a caregiver from the nursing home.

The patient has a medical history of severe chronic obstructive pulmonary disease, hypertension, and osteoarthritis of multiple axial skeletal joints that is treated with scheduled codeine for analgesia. She has variable oral intake and is frequently constipated, with up to 4 days between bowel movements. She has used various cathartic and stool-softening agents, without significant improvement. A review of her medical chart reveals that the patient had two previous admissions for fecal impaction.

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