Constipation and recurrent abdominal distension in a 39-year-old woman with irritable bowel syndrome.

摘要

A 39-year-old woman with a previous diagnosis of irritable bowel syndrome presented with progressively" worsening episodes of marked abdominal distension and difficulties with defecation. She had a long history of constipation and had tried a variety of laxatives with an unsatisfactory response. Recent colonoscopy was unremarkable. Physical exam revealed a protuberant abdomen with tympany and high-pitched bowel sounds. Inspection of the anus showed no perianal lesions and absent perineal descent with straining at defecation. A digital rectal examination revealed high anal sphincter tone and absence of puborectalis relaxation with simulated defecation. There was no palpable stool in the rectum. Computed tomographic enter-ography with scout film showed a markedly dilated splenic flexure without obstructing mass or volvulus (Figure 1 and Figure 2).