Patient populations vulnerable to chronic constipation include, but are not limited to, the elderly, persons with dementia, those with damage to the autonomic nervous system, infectious diseases, or intestinal vascular compromise.
[citation needed] Ensuring a proper diagnosis involves a variety of tools by the clinician.
Rebound tenderness or guarding may present with perforation of the ulcer with air leaking into the abdomen.
These patients may even have blood on their rectal exam, due to passing small amounts of stool around the ulcer and adjacent fecaloma.
[2] Patients may have unstable vital signs if they have been having rectal bleeding, have developed stercoral colitis, and/or have had a perforation of the ulcer.
These vital sign changes may be an acute fever, elevated heart rate, and/or decreased blood pressure.
If a patient presents with severe symptoms it may be useful to order blood cultures and preoperative labs such as type and screen and coagulation testing.
Patients who are acutely ill and showing signs of perforation will need an upright Chest x-ray to determine if there is free air in the peritoneum.
The imaging study of choice is an CT scan of the abdomen with IV contrast, considering the patient's renal function is adequate.