Patient history A 23-year-old woman has come to see you with a complaint of severe constipation. She describes a year's history of difficulty opening her bowels, with a frequency of once per week of hard, pellet-like stool. Her previous bowel habit was once every three days. There was no blood or mucus, no straining at stool, and no urge to defecate. She describes a nagging discomfort in her left lower abdomen, which is not relieved by defecation.
Over the last few months, the woman has developed nausea and a bloated sensation, especially after eating. There have been a few episodes of vomiting. She has a poor appetite but claims to have gained 10 kg weight in the last four months Physical examination Examination revealed a distended abdomen, tender left flank with palpable feces in the colon and sluggish bowel sounds. There was a normal sphincter tone with no feces in the rectum. There…
