Problem 17 Nausea and constipation in an older woman
A 68-year-old woman presents with a 2-day history of nausea and constipation. She has not been able to eat or drink anything in the last 2 days because of the nausea. Her co-morbidities include obesity (BMI = 41), type II diabetes, hypertension, sleep apnoea and carcinoma of the rectum treated 2 years previously by abdoperineal excision and end colostomy. Her medications include simvastatin, perindopril and gliclazide. The patient has now developed colicky and generalized abdominal pain and has vomited once.
On examination the patient appears uncomfortable and in pain. Her pulse is 90 bpm and blood pressure 148/88 mmHg. The cardiopulmonary examination is unremarkable. Her abdomen is obese and appears distended with mild tenderness to palpation. She has a lower midline scar from umbilicus to pubis and a left iliac fossa colostomy. There is no palpable mass in the abdomen or either groin. The stoma appears healthy.
The results of the investigations are shown below and in Figures 17.1 and 17.2.
A CT scan of the abdomen is performed. Two representative images are shown in Figures 17.3 and 17.4.
