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JAMA Surgery Clinical Challenge |

An Older Female Patient With Abdominal Distention QUIZ

Hao-Yu Lin, MD1; Yuan-Huei Huang, MD, PhD1; Ming-Chi Yang, MD1
[+] Author Affiliations
1Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
JAMA Surg. 2016;151(8):773-774. doi:10.1001/jamasurg.2016.0240.
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An 84-year-old woman presented with 2 days of progressive abdominal distention and nausea, a distended abdomen without peritoneal signs on examination, an elevated white blood cell count, and segmental small-bowel dilatation on abdominal x-ray. What is your diagnosis?

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Figure 1.

A, Computed tomographic scan showing small-bowel ileus. B, Computed tomographic scan showing a mass lesion in the right lower pelvic wall.

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Figure 2.

Right obturator hernia sac containing a bowel loop (arrowhead) and contralateral small obturator hernia sac.

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