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Special Feature |

Image of the Month—Quiz Case FREE

Nasser M. Amer, FRCS; David Johnston, FRCS; Jacque Gutmann, FRACR
[+] Author Affiliations

Author Affiliations: Department of General Surgery, Newham University Hospital, Plaistow, London (Dr Amer), and Departments of General Surgery (Dr Johnston) and Radiology (Dr Gutmann), Old Church Hospital, Romford, Essex, England.


Arch Surg. 2006;141(8):833. doi:10.1001/archsurg.141.8.833.
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A 73-year-old woman came to the surgical department with acute central abdominal pain and vomiting. She had no similar attacks in the past, and her medical history was not significant. On examination, she was in pain, was dehydrated, and had a distended and tender abdomen, mainly in the left iliac fossa. Her bowel sounds were diminished, and rectal examination results were not significant. Following fluid resuscitation, a barium enema and magnetic resonance imaging were arranged (Figure 1 and Figure 2).

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Figure 1.

A barium enema showed the soft indentation caused by the lipoma (arrow) of the colon in contrast to the apple-core appearance of malignant lesions.

Graphic Jump Location

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Figure 2.

A magnetic resonance image of the colon showed intussusception. Notice the lead point caused by the well-defined high T2-weighted signal, indicating a lipoma (arrow), 9 cm from the anal verge.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Volvulus

B. Intussusception caused by cancer

C. Intussusception caused by lipoma of the colon

D. Simple obstruction caused by a large adenoma

Figures

Place holder to copy figure label and caption
Figure 1.

A barium enema showed the soft indentation caused by the lipoma (arrow) of the colon in contrast to the apple-core appearance of malignant lesions.

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

A magnetic resonance image of the colon showed intussusception. Notice the lead point caused by the well-defined high T2-weighted signal, indicating a lipoma (arrow), 9 cm from the anal verge.

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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