CASE 2
A 65-year-old male was on psychiatric treatment for obsessive-compulsive disorder for the past 8 years with clomipramine 50 mg/day and nitrazepam 10 mg/per day. Over the previous 3 months, his food intake had gradually decreased and he developed constipation. Over the past 1 week, he developed abdominal distension with pain. The consulting surgeon made a preoperative diagnosis of subacute large bowel obstruction due to a suspected carcinomatous lesion. The antidepressant was stopped and the patient was investigated. Plain radiographs of the abdomen revealed signs of obstruction with multiple faecoliths and no evidence of intestinal perforation. Barium enema revealed obstruction at the rectosigmoid junction and a sigmoid volvulus.
An exploratory laparotomy was done to rule out bowel cancer and a final diagnosis of atonic pelvic colon was made. The patient recovered completely.