A 61-Year-Old Woman With Painful Constipation

Winston Tan, MD; Matthew Tan

Disclosures

October 12, 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

A 61-year-old woman with a history of stage III breast cancer (T3N2MX; estrogen receptor-negative/progesterone receptor-negative) 7 years prior presents to a primary care clinic with painful constipation. She had previously undergone bilateral mastectomy for lobular breast cancer (positive in 19 nodes). She received six cycles of cyclophosphamide, doxorubicin (Adriamycin), and 5-fluorouracil (CAF) and has been taking anastrozole for 7 years. She also has a history of multiple sclerosis, with recurrent symptoms every 4-6 months for the past 4-5 years, and is receiving intermittent steroid treatment.

The patient presents to the clinic with constipation over the past 3-4 months, with smaller-caliber stools noted particularly in the past few months. She has had a hard time passing her stools, with increasing difficulty and increased pain. Over the past week, she has also found urinating difficult. She has had hesitancy, frequency, and dysuria.

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