Case 23-1971

Presentation of CaseA 40-year-old woman was admitted to the hospital because of a question of metastatic malignant tumor.She had been well until three years previously, when vague digestive symptoms developed. An upper gastrointestinal series and oral cholecystograms were reported to be normal, and a barium-enema examination showed only diverticulosis of the colon. With a low-roughage diet the symptoms improved. Three weeks before admission there was the onset of periumbilical cramps, nausea and constipation. Because of marked obstipation she entered a hospital for observation. Shortly after admission she passed a massive stool; she had normal bowel movements thereafter. X-ray . . .