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Special Feature | Dec 2012

Image of the Month—Diagnosis

Arch Surg. 2012;147(12):1148. doi:10.1001/archsurg.2011.2032b.

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Correspondence: Kensuke Adachi, MD, PhD, Department of Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan (kensuke_adachi@tmhp.jp).

Accepted for Publication: November 16, 2011.

Author Contributions: Study concept and design: Adachi. Acquisition of data: Adachi. Analysis and interpretation of data: Adachi and Minami. Drafting of the manuscript: Adachi. Critical revision of the manuscript for important intellectual content: Adachi and Minami. Administrative, technical, and material support: Minami. Study supervision: Adachi and Minami.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Kazuaki Enatsu, MD, PhD, provided expertise in pathologic diagnosis and interpretation.

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Figure 1. Endoscopic and computed tomographic images. A, Emergent upper gastroduodenal endoscopy demonstrated hemobilia emerging from the papilla of Vater. B, Abdominal computed tomography with intravenous contrast demonstrated massive clots in the gall bladder and duodenum. C, Another caudal slice of the computed tomographic scan.

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Figure 2. Histological investigation of the resected specimen showed chronic fibrous inflammatory changes due to alcoholic pancreatitis, accompanied by microfistula formation (black arrow) between the bile duct (yellow arrow) and irregularly disrupted vessel-like structures (white arrow) (elastica van Gieson stain, original magnification ×2).

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Image of the Month—Diagnosis. Arch Surg. 2012;147(12):1148. doi:10.1001/archsurg.2011.2032b.

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