A 74-year-old woman presents for evaluation of left hip pain after sustaining a fall earlier in the day while walking. She tripped on a step and landed on her left side. She denies any dizziness or weakness. Her medical history is significant for osteoarthritis, hypertension, and coronary artery disease.
Physical examination shows an elderly female in no obvious distress, with normal vital signs. She has some mild tenderness in the left hip but no obvious deformity and overall good range of motion. Pelvis radiograph is obtained and shown.
Answer
The radiograph demonstrates no obvious fracture or dislocation. There is significant degenerative disk disease of the lower lumbar spine with some associated scoliosis. There are also metallic fragments over the left pelvis, presumably related to a previous gunshot wound.
Of note, the patient has findings consistent with an extremely large rectal fecal impaction. If not treated, this problem could progress to something more serious, such as an ileus or obstruction.
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