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Special Feature |

Image of the Month—Quiz Case FREE

Naren Gupta, MD, PhD; Bruce D. Schirmer, MD; C. Joe Northup, MD
[+] Author Affiliations

Author Affiliations:Department of Surgery, University of Virginia Health System, Charlottesville.


Section Editor: Grace S. Rozycki, MD, MBA


Arch Surg. 2008;143(3):309. doi:10.1001/archsurg.143.3.309.
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Published online

A 47-year-old man presented to the emergency department with a 3-day history of right lower quadrant abdominal pain, fever, and loss of appetite. The patient's medical history was significant for a recent unintentional 20-pound weight loss, constipation, night sweats, asthma, and tobacco and alcohol abuse, without any prior episodes of similar abdominal pain. He had an elevated white blood cell count and was tachycardic on examination, with peritoneal signs in the right lower quadrant. Abdominal computed tomography revealed a contrast-containing 4.4 × 6.6-cm mass in the right lower quadrant with associated inflammatory changes (Figure 1). On laparoscopic exploration, mobilization of the cecum and right colon demonstrated a necrotic mass in the ileocecal region (Figure 2).

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Figure 1.

Abdominal computed tomography shows a contrast-containing 4.4 × 6.6-cm mass in the right lower quadrant with inflammatory changes surrounding the inferior aspect.

Graphic Jump Location

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Figure 2.

Laparoscopic view of the mass (A) and its relation to the cecum after being dissected off the anterolateral abdominal wall (B).

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Appendicitis

B. Cecal cancer

C. Cecal diverticulitis

D. Ileocecal tuberculosis

Figures

Place holder to copy figure label and caption
Figure 1.

Abdominal computed tomography shows a contrast-containing 4.4 × 6.6-cm mass in the right lower quadrant with inflammatory changes surrounding the inferior aspect.

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

Laparoscopic view of the mass (A) and its relation to the cecum after being dissected off the anterolateral abdominal wall (B).

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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