Constipation can often be traced back to changes in routine and diet, but for this US patient, it was a primary symptom of a previously undetected rectosigmoid carcinoma.

The 56-year-old presented to a Chicago ED, reporting abdominal pain and a lack of bowel movements for nine days, without flatus.

He had a history of alopecia and gastro-oesophageal reflux disease but otherwise no significant contributory factors.

On examination, his abdomen was largely distended and non-tender, the case doctors wrote in Cureus.