A 61-Year-Old Woman With Painful Constipation

Winston Tan, MD; Matthew Tan


October 12, 2017

Physical Examination and Workup

Upon physical examination, the patient is conscious, coherent, and not in respiratory distress. She is 5'3" tall and weighs 110.2 lb. Her blood pressure is 112/84 mm Hg, heart rate is 76 beats/min, respiratory rate is 14 breaths/min, and temperature is 97.34°F.

On head, eye, ear, nose, and throat examination, the pupils are both equally reactive to light. Extraocular muscle movements are intact. The nose and throat are both clear. No neck adenopathy or supraclavicular adenopathy is noted.

Cardiovascular examination reveals regular S1 and S2 sounds, with no S3 or S4 sounds. The lungs sound clear. The abdomen is soft and nontender, with no hepatosplenomegaly noted. No edema, cyanosis, or clubbing is observed.

Examination of the patient's breasts reveals no mass or nodule in her right breast area. In her left breast area, no mass or nodule is found. No axillary adenopathy is observed. No signs of recurrence are evident.

The patient's multiple sclerosis appears to be stable. Rectal examination reveals a mass that is obstructing the rectal outlet (Figure 1). It is nontender, solid, and firm, with no bleeding. Colonoscopy reveals a mass in the rectal sigmoid junction, causing at least 80% obstruction.

Figure 1.


PET of the head and neck reveals no abnormal hypermetabolic activity. No abnormal hypermetabolic activity is noted in the patient's chest. Hypermetabolic activity is noted in the pelvis, with thickening of the rectal wall. Soft-tissue density is observed adjacent to this rectum thickening. Moderate right hydronephrosis and mild left hydronephrosis are also noted.


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