Sudden Fatal Abdominal Pain in an Old Man With Chronic Constipation

Abstract

Question: A 66-year-old man presented with a 4-hour history of sudden severe abdominal pain. The medical history was notable for a chronic constipation. Vital signs were temperature 38.6°C; pulse, 98 beats per minute; respirations, 23 breaths per minute; blood pressure, 107/86 mm Hg; and an oxygen saturation of 80% on room air. Physical examination showed abdominal distension, tenderness, and signs of peritonitis. A computed tomography scan of the abdomen revealed a pneumoperitoneum in the upper abdomen, a large amount of feces around and loading in the sigmoid colon, and several large fecalomas in the distal sigmoid colon (Figure A, B, arrow).