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JAMA Surgery Clinical Challenge |

Right Iliac Fossa Pain QUIZ

Mohamed O. Soliman, FRCSI1; Emad H. Ayyash, FRCSEd1; Ahmad A. Al Mosawi, FRCSI1; Sami Asfar, MD, FRCS1,2
[+] Author Affiliations
1Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait
2Department of Surgery, Faculty of Medicine, Kuwait University
JAMA Surg. 2013;148(12):1159-1160. doi:10.1001/jamasurg.2013.773.
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Figure 1.

Abdominal ultrasonographic image revealing a 4.2 × 4.2-cm mass with central echogenicity, the “donut sign” (A). Abdominal computed tomographic scan with oral contrast agent revealing a 8.2 × 4 × 2.6-cm tubular thin-walled filling defect in the cecum and lower part of ascending colon (B). The contrast is seen around, proximal, and distal to the defect, with no obstruction noted.

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Figure 2.

Right hemicolectomy specimen showing the terminal ilium and ileocaecal valve (single asterisk), the cecum and ascending colon (double asterisk), the appendix (black arrowheads), and the direction of appendicular intussusception into the cecum (yellow arrowhead).

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