Chronic Constipation Led This Young Woman to Seek Medical Care — Her X-Ray Told a Surprising Story

Constipation is usually uncomfortable rather than dangerous. A few days of infrequent bowel movements, hard stools, or straining can often be related to diet, dehydration, medications, changes in routine, or lack of physical activity.

But when constipation becomes severe—especially when it occurs together with progressive abdominal swelling and significant pain—it can sometimes point to a much more serious problem.

One published medical case illustrates this dramatically: a previously healthy 33-year-old woman went to the emergency department after experiencing constipation, increasing abdominal distension, and abdominal pain. What initially appeared on an X-ray to resemble a stool blockage turned out to be something very different. Further imaging revealed a sigmoid volvulus, a twisting of part of the large intestine that can cause a dangerous bowel obstruction.

The Case That Surprised Doctors

According to the case report published in The Journal of Emergency Medicine, the woman had experienced the combination of constipation, progressive abdominal fullness, and diffuse abdominal pain for three days.

She was young and previously healthy—making the eventual diagnosis particularly unusual.

Her initial plain abdominal X-ray could resemble fecal impaction, a condition in which hard stool becomes stuck in the rectum or colon. However, a CT scan provided the crucial clue: it showed the characteristic findings of a sigmoid volvulus, including the “coffee bean” and “whirl” signs.

Doctors subsequently found that her sigmoid colon was unusually elongated and had twisted around the tissue supporting it. The bowel was then successfully untwisted and stabilized.

The case is a reminder that not every episode of severe constipation is simply a buildup of stool.

What Is a Sigmoid Volvulus?

A volvulus occurs when part of the intestine twists around the tissue that holds it in place.

When this happens in the sigmoid colon—the lower portion of the large intestine—it is called a sigmoid volvulus.

The twisting can block the passage of stool and gas. More seriously, it can restrict blood flow to the affected portion of the bowel. If blood supply is severely compromised, the intestinal tissue can become damaged or die, potentially leading to perforation, peritonitis, sepsis, or shock.

That is why a suspected volvulus requires prompt medical attention.

Why Can It Happen?

Sigmoid volvulus is more commonly seen in older adults, particularly people with chronic constipation and certain medical or neurological conditions. However, younger people can develop it as well.

One important anatomical factor is a long or unusually mobile sigmoid colon. This can provide more opportunity for the bowel to twist. Chronic constipation may also be associated with an increased risk.

Several published case reports have documented sigmoid volvulus in young women, demonstrating that age alone does not completely rule out the condition. For example, a 28-year-old healthy woman developed constipation and abdominal pain that progressed to vomiting and severe pain; CT imaging identified sigmoid volvulus, and she required emergency surgery.

A more recent 2026 case report also described sigmoid volvulus in a previously healthy young woman, again highlighting how unusual presentations can make diagnosis more difficult.

What Symptoms Should You Watch For?

Constipation by itself is extremely common. But constipation accompanied by certain symptoms should receive more attention.

1. Severe or worsening abdominal pain

Mild discomfort can occur with ordinary constipation. Persistent, severe, or progressively worsening abdominal pain is different.

NIDDK recommends seeking medical attention promptly when constipation occurs with constant abdominal pain.

2. Increasing abdominal swelling

A noticeably distended abdomen—particularly when the swelling continues to increase—can occur with intestinal obstruction and volvulus.

In the published young-woman case, progressive abdominal distension was one of the key features that ultimately pointed toward the diagnosis.

3. Inability to pass gas or stool

A bowel obstruction can prevent both stool and gas from moving through the intestine.

NIDDK specifically lists an inability to pass gas as a reason to seek medical care promptly when constipation is present.

4. Nausea or vomiting

Vomiting together with constipation, abdominal pain, and swelling can be a warning sign of intestinal obstruction.

Volvulus commonly presents with some combination of abdominal pain, bloating, constipation, nausea, and vomiting.

5. Symptoms that suddenly become much worse

Someone who has experienced constipation for a while but then develops sudden severe pain, rapidly increasing abdominal distension, or vomiting should not simply take more laxatives and wait.

Those symptoms can indicate an obstruction or another acute abdominal problem that requires medical assessment.

What Does an X-Ray Show?

Imaging can be extremely helpful when doctors suspect a bowel obstruction.

An abdominal X-ray may reveal characteristic patterns associated with sigmoid volvulus. One classic appearance is called the “coffee bean” sign, caused by the markedly enlarged, twisted sigmoid colon.

However, an X-ray does not always provide the complete answer. In the 33-year-old woman's case, the initial X-ray could mimic fecal impaction, while CT imaging revealed the characteristic signs of volvulus.

NIDDK notes that doctors may use X-rays, CT scans, or other imaging studies when evaluating suspected colonic volvulus.

Why Chronic Constipation Shouldn't Always Be Ignored

Most constipation is not caused by an intestinal obstruction.

Common causes include insufficient fiber or fluids, low physical activity, certain medications, changes in routine, and functional gastrointestinal disorders.

But persistent constipation can sometimes be a symptom of an underlying medical condition.

NIDDK recommends talking with a healthcare professional when constipation does not improve with self-care or continues for a long time.

The goal is not to become alarmed by every episode of constipation. Instead, it is to recognize when the symptoms are unusual, persistent, or accompanied by warning signs.

When Should You Seek Urgent Care?

If constipation occurs together with constant or severe abdominal pain, significant abdominal swelling, vomiting, fever, blood in the stool, unexplained weight loss, or an inability to pass gas, medical evaluation is important.

If symptoms suggest an intestinal obstruction—particularly severe pain, vomiting, marked distension, and inability to pass stool or gas—seek urgent medical attention rather than trying to treat the problem at home.

A volvulus can compromise blood flow to the intestine, and untreated complications can become life-threatening.

The Takeaway

The story of the 33-year-old woman is unusual, but it carries an important lesson: being young and otherwise healthy does not make serious intestinal problems impossible.

Her symptoms initially suggested constipation and possible stool impaction, but further imaging revealed a twisted sigmoid colon.

Most people with constipation will never develop a volvulus. Still, constipation accompanied by progressive abdominal swelling, severe pain, vomiting, or inability to pass gas or stool should never be casually dismissed.

Sometimes, the difference between ordinary constipation and a medical emergency is not how the problem starts—but how the symptoms change over time.

If your constipation is persistent or suddenly becomes much worse, especially with severe abdominal symptoms, contact a healthcare professional promptly.

Sources

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — Colonic Volvulus.
• NIDDK — Symptoms & Causes of Constipation.
• PubMed / The Journal of Emergency Medicine — Sigmoid Volvulus in a Young Woman Nearly Misdiagnosed as Fecal Impaction.
• Surgical Case Reports — A case of sigmoid volvulus in an unexpected demographic.
• Frontiers in Surgery (2026) — Sigmoid volvulus and incidental enterobiasis in a young adult: a case report.