A 74-year-old woman has a 10-year history of intermittent lower abdominal pain. The pain has been colicky in nature and is associated with a feeling of distension in the left iliac fossa. It is generally relieved by passing flatus or feces. She tends to be constipated and passes small pieces of feces. Four years previously she passed some blood with her bowel movements and had a barium enema performed. This is shown in the attached figure . Over the last week her pain has worsened and now she has continuous pain in the left iliac fossa and feels generally unwell.
Her appetite has been poor over this same time. She has not had her bowels open over the last 2 days. In her previous medical history, she had a hysterectomy for fibroids 20 years ago. There is a family history of ischemic heart disease and diabetes mellitus. She lives alone and does her own cooking and shopping. Examination:…
