A 56-Year-Old Woman With Severe Chronic Constipation: What Is the Underlying Pathology?

CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Figure 1. Abdominal X-ray and CT findings. (A) The plain abdominal radio-graph shows ileus with multiple air-fluid levels. (B) Abdominopelvic CT reveals marked colonic distensions with abundant feces and fluid from cecum to sig-moid colon, whereas the entire colon is well traced without a definite obstructive lesion. A 56-year-old woman with chronic constipation visited Chung-Ang University Hospital. She had suffered from chronic constipation , abdominal pain and abdominal distention, and took pro-kinetics, bulking agents and osmotic laxatives for more than 5 years. Her symptoms became worse and she could defecate only 3 or 4 times per a month. She had no history of any specific medical disease or trauma. The abdomen was distended without palpable mass. The laboratory findings were not remarkable. The plain abdominal radiograph showed ileus with air-fluid levels (Fig. 1A). Abdominopelvic CT revealed a marked colonic distension, whereas the entire colon was well traced without a definite obstructive lesion (Fig. 1B). During the colonoscopy and double-contrast barium enema, there was neither an intra-lumi-nal lesion nor narrowed segment which was suggestive of transi