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Special Feature |

Image of the Month—Quiz Case FREE

T. Christopher Windham, MD; Philip A. Rascoe, MD; Alberto Madrid, MD
[+] Author Affiliations

From the Department of Surgery, University of Texas[[ndash]]Houston (Drs Windham and Rascoe); and the University of Surgery, Lyndon B. Johnson Hospital (Dr Madrid), Houston, Tex.

Section Editor: Grace S. Rozycki, MD

More Author Information
Arch Surg. 2003;138(7):807. doi:10.1001/archsurg.138.7.807.
Text Size: A A A
Published online

A 64-YEAR-OLD diabetic, hypertensive, obese woman came to the emergency department with a 5-day history of diffuse abdominal cramps. Two weeks prior, she reported an episode of acute right upper quadrant pain lasting a few hours and associated with nausea and vomiting. She had watery diarrhea during the last 2 days and 1 episode of nonbilious emesis the morning of admission. Her abdomen was soft and nontender but moderately distended. The findings on rectal examination were unremarkable. Further testing was performed (Figure 1).


A. Fecalith

B. Gallstone ileus

C. Bezoar

D. Volvulus


Corresponding author: Alberto Madrid, MD, Department of Surgery, Lyndon B. Johnson Hospital, 5656 Kelley St, Suite 30S62008, Houston, TX 77026.




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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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