A 61-Year-Old Woman With Painful Constipation

Winston Tan, MD; Matthew Tan


October 12, 2017

Editor's Note:

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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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