Hindawi Publishing Corporation Case Reports in Surgery Volume 2013, Article ID 608505, 2 pages http://dx.doi.org/10.1155/2013/608505 Case Report Chronic Constipation in the Elderly: An Unusual Presentation of Colonic Dysmotility in an Elderly Patient R. Peravali, 1 H. Kranenburg, 1 J. E. Martin, 2 and N. Keeling 1 1 Department of Colorectal Surgery, West Sufolk NHS Foundation Trust, UK 2 BICMS Pathology Group, Barts and Te London School of Medicine and Dentistry, University of London, UK Correspondence should be addressed to R. Peravali; rajeevperavali@doctors.org.uk Received 19 May 2013; Accepted 23 June 2013 Academic Editors: C. Foroulis and G. La Greca Copyright © 2013 R. Peravali et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Chronic constipation is common in the elderly, and ofen no underlying pathology is found. Primary colonic dysmotility has been described in children but is rare in the elderly. Case report. We present an 82-year-old female with long standing constipation presenting acutely with large bowel obstruction. Laparotomy and Hartman’s procedure was performed, and a grossly distended sigmoid colon was resected. Histology revealed a primary myopathic process. Conclusion. Primary colonic myopathy should be considered in elderly patients presenting with large bowel obstruction and a long preceding history of constipation, particularly when previous endoscopic examinations were normal. 1. Introduction Primary colonic dysmotility secondary to a myapothic pro- cess has been described in children presenting with chronic constipation [1, 2]. Only two cases have been reported in adults aged 45 and 60 [3]. We report the only case in the English literature of primary colonic myopathy presenting acutely with large bowel obstruction in a patient over 80 years of age. 2. Case Report Tis 82-year-old female presented with gross abdominal distension and lower abdominal pain as an emergency. Her normal bowel habit was that of longstanding constipation, but she had loose stools over the preceding week. Accompanied with this, she had a six-week history of nonspecifc malaise, loss of appetite, and dizziness. She had previously been admitted to a hospital 13 years ago with a 5-month history of abdominal distension, consti- pation, and faecal incontinence. Abdominal X-ray revealed gross faecal impaction which was managed successfully with phosphate enemas. Follow-up fexible sigmoidoscopy and biopsies revealed nonspecifc colitis and melanosis coli. Past medical history included hypertension and impaired glucose tolerance. Past surgical history was a previous cae- sarean section many years ago. On examination, the patient was tachycardic (HR 115), hypotensive (BP 80/44), and tachypnoeic (RR 24). She had a nontender, grossly distended abdomen with an indentable mass in the lower lef quadrant. Blood tests revealed acute renal failure (urea 16.1 mmol/L, creatinine 131 umol/L) and microcytic anaemia (Hb 7.7 g/dL, MCV 66.8 fL). CRP was 55 mg/L, and WCC was 9.1 × 10 9 /L. CT scan revealed massive dilatation of the sigmoid colon with faecal material within, measuring up to 17.9cms in diameter, and no evidence of mechanical obstruction or perforation (Figure 1(a)), that is, no transition point was seen and the rectum was dilated and faecally loaded. She had resulting bilateral renal tract obstruction. Her abdominal tenderness and pain worsened, and a clinical decision was made to take her for laparotomy rather than endoscopy or contrast enema. At laparotomy, she was found to have massive colonic dilatation of the sigmoid and descending colon (Figure 1(b)), but the transverse and right colons were only moder- ately dilated. Tere dense perirectal fbrosis throughout the length of the rectum. Te rectum was resected at the mid rectum, and a Hartman’s procedure was performed.