Constipation, Abdominal Pain, and a Strong Family History

Clinical Presentation

A 49-year-old black woman presents with severe abdominal pain and constipation. The patient reports a 3-week history of nausea and vomiting, failure to have a bowel movement, and increasing abdominal girth.

Physical examination and review of systems reveal no hematuria or rectal bleeding, no breast tenderness, and no abnormal hair growth. Her relevant history includes:

• Medical history: patient denies any medical problems; has not seen a physician for 10 years;

• Surgical history: supracervical hysterectomy for "pelvic infection" in her 20s;

• Obstetrical history: no pregnancies;

• Gynecologic history: menarche at age 14 years; current menses regular (every 30 days, lasting 3-4 days) without intermenstrual spotting; no history of sexually transmitted infections or abnormal Pap test results;

• Family history: has 2 sisters with breast cancer diagnosed in their 40s; another sister with ovarian cancer diagnosed in her 30s;

• Social history: alcohol abuse (6-8 drinks/day); occasional marijuana use; is married and currently unemployed;

• Medications: ibuprofen; and

• Allergies: none.

Laboratory Studies and Imaging

• CA 125: 205 units/mL

• Beta-hCG: 0.01 mIU/mL

• A CT scan was obtained (Figure 1)

Figures 1a and 1b. CT scans upon initial presentation.

A CT-guided biopsy was performed to obtain a tissue diagnosis. The pathology report confirmed a primary ovarian cancer, and the CT scan confirmed metastatic disease.

Medscape Ob/Gyn © 2011  WebMD, LLC

Cite this: LaRae Brown. Constipation, Abdominal Pain, and a Strong Family History - Medscape - Nov 10, 2011.