A 56-year-old woman with moderate congenital mental retardation, dyslipidemia and hypothyroidism presented to the hospital with progressive constipation, increased abdominal perimeter and loss of 8 kg of weight in the last 4 months.
The physical examination highlights the central tendency of a hypogastric mass, hard, poorly defined, approximately 10 x 8 cm. Analytical determinations, including acute phase reactants and gastrointestinal and gynecological tumor markers.
CT scan was performed associated with pelvic renal necrosis showing a giant dilation of the rectum and left colon, occupied throughout the lumen by compacted fecal remains, producing displacement of all abdominal organs without hydronephrosis.
Pathologic examination to blind with pelvic MRI is normal.
An anorectal mantle conservation was performed, demonstrating inhibitory rectoanal reflex.
Treatment was initiated with polylenglycol oral and lactulose enema, with significant clinical improvement and currently continues maintenance therapy with high-dose oral lactulose with gain and deposition every 24-48 hours.
