Clinical Images  |   August 2018
Unusual Cause of “Constipation”
Author Notes
  • From the Rowan University School of Osteopathic Medicine and the Department of Emergency Medicine at Jefferson Health in Stratford, New Jersey. Dr Lee is a second-year resident. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to James Lee, DO, Department of Emergency Medicine, Rowan University, 18 E Laurel Rd, Stratford, NJ 08084-1350. Email:
Article Information
Emergency Medicine / Endocrinology / Imaging / Obstetrics and Gynecology / Clinical Images
Clinical Images   |   August 2018
Unusual Cause of “Constipation”
The Journal of the American Osteopathic Association, August 2018, Vol. 118, 561. doi:
The Journal of the American Osteopathic Association, August 2018, Vol. 118, 561. doi:
A 60-year-old woman with no known medical history presented to the emergency department with 5 days of constipation and lower abdominal cramping. She reported nausea and 1 episode of nonbloody, nonbilious emesis, along with a 50-lb weight loss, which she attributed to lifestyle changes. Physical examination revealed suprapubic tenderness, right abdominal distension, and mild lower extremity edema. Computed tomographic findings (images A and B) revealed a large cystic mass arising from the pelvis and extending into the abdomen, with multiple septations. The patient underwent resection of 2 separate masses. Pathologic testing identified a benign ovarian cystadenoma. On follow-up, the patient's symptoms had resolved. 
A gynecological mass can often be grouped based on a patient's reproductive status and age. In women of reproductive age, the most common benign neoplasms are cystadenomas and mature cystic teratomas.1 At least 30% of ovarian masses in postmenopausal women are malignant.2 
Seidman JD, Mehrotra A. Benign ovarian serous tumors: a re-evaluation and proposed reclassification of serous “cystadenomas” and “cystadenofibromas.” Gynecol Oncol. 2005;96(2):395-401. doi: 10.1016/j.ygyno.2004.10.014 [CrossRef] [PubMed]
Kinkel K, Lu Y, Mehdizade A, Pelte M-F, Hricak H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization—meta-analysis and Bayesian analysis. Radiology. 2005;236(1):85-94. doi: 10.1148/radiol.2361041618 [CrossRef] [PubMed]