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Huang WC et al. – A 29–year–old man underwent a pull–through procedure for imperforate anus at birth. He had been bothered by difficulty with defecation and irregular bowel habits for >20 years. Because he had remained in good health, he did not seek further medical investigation. About 5 days before admission, he noticed progressive abdominal distention and swelling of the lower limbs. On admission he was thin and had an ovoid abdomen, which was dull on percussion.

   

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