History A 65-year-old woman presents to the accident and emergency department with a complaint of vomiting. She is known to have metastatic ovarian carcinoma with a large primary tumor that is invading surrounding structures. There are lung and liver metastases. She has recently completed a course of chemotherapy. She complains of a long history of variable bowel habit and has not opened her bowels for the last 2 days. Examination She looks thin and in discomfort.
There is mild dehydration, no fever and observations are normal. She has a distended abdomen that is soft but generally tender. There are hyperactive bowel sounds on auscultation. Her chest is clear and heart sounds are normal. You arrange an abdominal radiograph (attached image-1), review the staging computed tomography (CT) scan of the pelvis from a few months previously that describes metastatic masses and organize a…
