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March 4, 1983

Colonic Obstruction: A Pelvic Mass in a 46-Year-Old Man

Author Affiliations

From the Department of Radiology, Veterans Administration Medical Center, and Mount Sinai School of Medicine, Bronx, NY.

JAMA. 1983;249(9):1195-1196. doi:10.1001/jama.1983.03330330073043

History  This 46-year-old man, admitted to the psychiatric service, was given amitriptyline hydrochloride, 125 mg daily, for depression. Six days later, nausea, vomiting, abdominal tenderness, and progressive distention of the abdomen developed. No bowel movement had occurred for two days. An anteroposterior roentgenogram of the abdomen demonstrated a large pelvic mass (Fig 1) with dilated large bowel. A prone horizontal-beam roentgenogram showed multiple airfluid levels, indicating large-bowel obstruction (Fig 2). An emergency barium enema examination showed a large mass compressing the colon extrinsically. The lumen of the sigmoid colon was narrowed and the mucosa appeared irregular, suggesting transmural involvement (Fig 3).Catheterization of the urinary bladder evacuated approximately 2.3 L of urine, and the signs and symptoms of intestinal obstruction disappeared. A postcatheterization barium enema examination outlined a normal colon.

Diagnosis  Mechanical obstruction of the sigmoid colon secondary to distention of the urinary bladder.

Comment  Distention of the urinary bladder