this is a 25ys male , who is complaining of chronic constipa | Figure 1

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Case Description: This is a 25-year-old male who is complaining of chronic constipation, abdominal distention, early satiety, epigastric distension after eating even a small meal, difficulty passing flatus. He presented to me complaining of masses that only present when he defecates and he also complains of passing mucus discharge.

He went to a surgeon who examined him with proctoscopy and told that everything is normal and advised him to sit in hot baths and avoid constipation.

Even though he still complains the same while using laxatives, no significant progress was noticed. No significant family history.

What is your plan for this patient?

Additional Cases

56y/o M came in complaining of abdominal bloating and early satiety for 3 weeks. Complaining also of constipation. He was initially given simethicone and Reglan. After a follow-up, he reported no improvement of symptoms. On exam, his abdomen was soft, non-tender, bowel sounds present, no guarding or rebound, no organomegaly, but slightly more distended on the left side. Evidence of constipation was observed along with new symptoms of intermittent nausea. Vitals were stable, CBC, chem panel, and UA were unremarkable. He had a hiatal hernia repair about 9 months prior without complications.

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