Abdomen and rectal discom...

The emergency department is visited by a 72-year-old woman with a history of narcotic bowel syndrome, many prior abdominal surgeries, and significant right lower abdomen and rectal discomfort that has been present for the past week. A sizable faeces ball is visible upon rectal examination. Bloodwork and an abdominal computed tomography scan are the patient's first diagnostic procedures (Figure). Except for a white blood cell count of 12,000/L with 77% polymorphonuclear leukocytes, the patient's laboratory results and liver function tests are within normal range.