CASE 13805 Published on 22.06.2016

Severe obstipation with all 24 markers accounted for in colon transit time examination


Abdominal imaging

Case Type

Clinical Cases


Barbara Bonnesen

Hellerup, Denmark;

56 years, female

Area of Interest Abdomen, Colon, Gastrointestinal tract ; No Imaging Technique
Clinical History
Patient with a history of paranoid schizophrenia and treatment with psychotropics, alcohol abuse and lately also immobilisation.
Developed problems with increased abdominal size, increased weight, diffuse abdominal pain and some fillings in the left fossa.
Imaging Findings
Colon transit time: Radiography of the abdomen 5 days after ingestion of a capsule containing 24 radioopaque markers shows all 24 markers still present in the gastrointestinal tract:
3 markers in small intestine segments.
18 markers in colon ascendens.
1 marker in colon transversus.
2 markers in colon sigmoideum.
Constipation is a known side effect of psychotropics that possess high affinity for muscarinic cholinergic receptors. In severe cases, constipation progresses to ileus and bowel ischaemia, with multiple fatalities related to sepsis and perforation described in the literature, primarily among patients with schizophrenia. [1]
Additionally patient with psychiatric illnesses often use morphine which can lead to opioid-induced bowel dysfunction through the peripheral opioid receptor system. [2]

The procedure is the administration of a single capsule containing 24 4.5 mm radioopaque markers followed by a plain abdominal radiography 5 days after ingestion. More than 5 markers visible has been identified as diagnostic of slow colon transit time. [3, 4]

The diagnosis can help the clinicians in adjusting the laxative treatment and considering opioid receptor antagonists if relevant. [5]
Differential Diagnosis List
Severe obstipation, probably attributet to regular intake of psychotropics.
Final Diagnosis
Severe obstipation, probably attributet to regular intake of psychotropics.
Case information
DOI: 10.1594/EURORAD/CASE.13805
ISSN: 1563-4086