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Special Feature |

Image of the Month—Quiz Case FREE

Kurt R. Stahlfeld, MD; Michael Edwards; Harry W. Sell, MD
[+] Author Affiliations

From the Department of Surgery, The Mercy Hospital of Pittsburgh, Pittsburgh, Pa.

Section Editor: Grace S. Rozycki, MD

Arch Surg. 2003;138(5):561. doi:10.1001/archsurg.138.5.561.
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Published online

A 65-YEAR-OLD man had a 1-week history of midepigastric pain, nausea, and vomiting. He denied any previous abdominal complaints. His medical history was significant for peripheral vascular disease, hypertension, a 2-pack-per-day smoking habit, and alcohol abuse (12 drinks per day). His physical examination was remarkable for an irregular heart rate of 124 beats/min, temperature of 38.4°C, and mild abdominal distention and tenderness, but no signs of peritonitis. His white blood cell count was 20.1 × 103µL and his sodium level was 119 mEq/L. Plain abdominal x-ray films were nonspecific.

Following aggressive fluid resuscitation and initiation of ampicillin-sulbactam and gentamycin, a computed tomographic (CT) scan of the abdomen (Figure 1) was obtained. Due to the retrogastric air-filled cavity seen on CT, he underwent celiotomy. The findings are shown in Figure 2.


A. Foramen of Winslow hernia

B. Duodenal diverticulum

C. Infected pancreatic pseudocyst

D. Perforated gastric ulcer

E. Intestinal duplication cyst




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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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