0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Image of the Month—Quiz Case FREE

Jonathan D. McCue, MD; Dilip S. Nath, MD; Bruce A. Bennett, MD
[+] Author Affiliations

Section Editor: Grace S. Rozycki, MD


Arch Surg. 2006;141(6):607. doi:10.1001/archsurg.141.6.607.
Text Size: A A A
Published online

An 84-year-old man who resided in a nursing home presented to the emergency department with a 3-week history of gradually worsening nausea, anorexia, and postprandial left upper quadrant abdominal pain with eventual food avoidance and greater than 10% weight loss. He had no difficulty passing flatus or having bowel movements. His surgical history was significant for an infrarenal abdominal aortic aneurysm repair 12 years prior to presentation. There was no known history of peptic ulcer disease, biliary disease, or malignancy. Physical examination revealed a cachectic man with a height of 1.7 m and weight of 45 kg. He was afebrile with a blood pressure of 130/70 mm Hg, pulse of 85 beats/min, respiratory rate of 22/min, and a 95% arterial oxygen saturation (SaO2) on room air. His abdomen was soft and nondistended with moderate left upper quadrant tenderness but no peritoneal signs. A midline surgical scar was well healed; no external hernias were evident. Rectal examination revealed no masses or occult fecal blood. Laboratory data and chest radiograph findings were unremarkable. A computed tomographic scan of the abdomen revealed a markedly distended stomach and dilated proximal duodenum with distal decompression. Esophagogastroduodenoscopy was performed, which revealed a narrowing of the distal portion of the duodenum with a grossly dilated stomach and proximal duodenum. There was no evidence of an intraluminal mass. An upper gastrointestinal tract barium study showed normal motility with failure of the fourth portion of the duodenum to completely opacify (Figure).

Place holder to copy figure label and caption
Figure.

Barium contrast upper gastrointestinal tract study shows vertical opacification of the fourth portion of the duodenum.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Abdominal aortic aneurysm

B. Crohn's disease

C. Superior mesenteric artery syndrome

D. Gastric outlet obstruction

Figures

Place holder to copy figure label and caption
Figure.

Barium contrast upper gastrointestinal tract study shows vertical opacification of the fourth portion of the duodenum.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
JAMAevidence.com

Users' Guides to the Medical Literature
Abdominal Aortic Aneurysm

The Rational Clinical Examination
Make the Diagnosis: Abdominal Aortic Aneurysm