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Not All Constipation is Created Equal

Published:October 13, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.09.005
      A 73-year-old man with past medical history of coronary artery disease presented with recurrent episodes of abdominal pain and constipation, relieved by enemas. He had a normal screening colonoscopy 6 years prior, and previous normal abdominal radiographs during such episodes. He again presented, complaining of 2 days of severe, localized left lower quadrant pain and initially, 2 loose non-bloody bowel movements that progressed to constipation. This was accompanied by diaphoresis, light-headedness, bloating, and nausea without vomiting. On presentation to the emergency department, he was hemodynamically stable, although febrile to 38.7°C. Pertinent physical examination demonstrated a non-distended abdomen with hypoactive bowel sounds and tenderness in the left lower quadrant with voluntary guarding, but no rebound tenderness. Blood work revealed mild leukocytosis at 11.8 × 103/uL, creatinine elevated from baseline at 1.19 mg/dL, elevated total bilirubin at 2.1 mg/dL, with otherwise unremarkable electrolytes and liver function tests. A computed tomography scan of the abdomen revealed a Meckel's diverticulum with focal mesenteric edema without any evidence of abscess formation (Figure).
      Figure
      FigureMeckel's diverticulum with focal mesenteric edema.
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