Naomi, an 81-year-old woman, presents to her local ED with intermittent cramping abdominal pain and a paucity of bowel motions.

Her bowels have not opened adequately for five days. She saw her GP two days prior and was referred for an abdominal X-ray that demonstrated faecal loading. However, she has not taken aperients as her GP advised, citing painful defecation and haemorrhoids affecting her ability to pass stool.

She has not passed flatus today, and her last bowel motion two days ago was “watery”. Naomi denies vomiting, fever or chest pain.

She has a past history of hypertension, for which she takes irbesartan 150mg daily, and breast cancer treated by lumpectomy and radiotherapy three years ago, for which she still takes tamoxifen 20mg daily.