Case Presentation:A 27-year-old female with a history of opioid use disorder with multiple overdoses, hepatitis C, hepatitis B, and opioid induced constipation requiring multiple admissions for colonic disimpaction presented with a 3-day history of abdominal pain, nausea and vomiting. She endorsed last using heroin 48 hours prior, endorsed having had her last bowel movement over 7-days prior and was well known to the emergency department staff. She was hemodynamically stable but tachycardic and hypertensive and endorsing significant abdominal pain. On exam she had a firm distended abdomen and hard stool in the rectal vault. A CT-scan was ordered to assess stool burden vs other causes of abdominal pain.