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Special Feature |

Image of the Month—Quiz Case FREE

Amir Behdad, MD; Rodney Chan, MD; Ali Tavakkolizadeh, MD; David Jacobsen, MD
[+] Author Affiliations

Author Affiliations:Department of Surgery, Brigham and Women's Hospital, Boston, Mass. Dr Behdad is now with the Department of Neurosurgery, Washington University in St Louis, St Louis, Mo.


Section Editor: Grace S. Rozycki, MD


Arch Surg. 2006;141(2):215. doi:10.1001/archsurg.141.2.215-a.
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Published online

A 54-year-old white man presented with abdominal pain, vomiting, and diarrhea. His symptoms had started 4 months earlier during a trip to Colorado, when he developed altitude sickness. Since then he had experienced intermittent episodes of nonbloody diarrhea alternating with constipation. A course of metronidazole hydrochloride did not affect the symptoms. On the day of admission, he presented with a severe episode of periumbilical pain and vomiting. His examination was notable for right lower-quadrant tenderness with a distended abdomen and a white blood cell count of 9320/μL.

A helical computed tomographic scan of the abdomen was obtained after oral contrast (Figure 1). The patient was taken to the operating room with a diagnosis of small-bowel obstruction secondary to ileoileal intussusception. Exploration of the abdomen revealed an intussusception of about 20 cm at the level of midileum. This was reduced and the bowel was completely viable. The lead point was an easily palpable intraluminal mass that was 6.5 cm long and 2 cm in diameter (Figure 2).

Place holder to copy figure label and caption
Figure 1.

Helical computed tomographic scan after oral contrast shows the characteristic “target”-shaped lesion within 1 of the distal small-bowel loops, indicating an ileoileal intussusception.

Graphic Jump Location

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Figure 2.

A tubular segment (6.5 cm long × 2 cm in diameter) protruding into the lumen of the bowel. The tubular segment has a swollen, red, granular tip.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Small-bowel adenocarcinoma

B. Small-bowel lymphoma

C. Inverted Meckel diverticulum

D. Small-bowel lipoma

Figures

Place holder to copy figure label and caption
Figure 1.

Helical computed tomographic scan after oral contrast shows the characteristic “target”-shaped lesion within 1 of the distal small-bowel loops, indicating an ileoileal intussusception.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

A tubular segment (6.5 cm long × 2 cm in diameter) protruding into the lumen of the bowel. The tubular segment has a swollen, red, granular tip.

Graphic Jump Location

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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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