Bowel Obstruction:

66 year old female recently diagnosed with Rectal Adenocarcinoma (MRI)

Presented with 9mo history:

 Rectal/anal pain
 Painful defection with haematochezia
 Tenesmus with very little bowel movement
 Loss of weight
 No abdominal pain or vomiting

On examination:
 Appears wasted
 Abdomen non-tender on superficial and deep palpation
 Mass palpated in hypogastric and umbilical region -pulsatile, non-tender, fixed
 DRE: Pain on insertion

Past Medical History:

 Recently diagnosed RVD
 Hypertension

Plan:
 Colonoscopy and CT