Authors Affiliations:Departments of Surgery (Drs Kirchhoff, Viehl, Heizmann, and Oertli) and Radiology (Dr Potthast) University of Basel, Basel Switzerland.
A 40-year-old woman presented to the emergency department with increasingly sharp abdominal pain in the left lower quadrant of 10 days' duration. Bowel movements were normal, the patient was afebrile, and blood test results, including a white blood cell count, were unremarkable. The physical examination showed localized pressure and percussion pain in the left lower abdomen. The patient reported that the same pain had appeared sporadically over the past 3 years, approximately twice a month and mostly during the night. She had been examined several times by a gynecologist without any pathologic findings. In addition, she had undergone a colonoscopy that revealed no abnormal findings.
In our emergency department, multislice computed tomography (CT) of the abdomen was performed after oral and intravenous administration of contrast agents. The CT scan showed thickening of the peritoneum and oval fat densities immediately adjacent to the descending colon, with surrounding edema and stranding (Figure 1). On laparoscopic exploration, a dark mass was apparent in the left lower abdomen, next to the descending colon. The mass was easily detached from the parietal peritoneum (Figure 2).
Abdominal computed tomography shows thickening of the peritoneum and localized pericolonic fat stranding next to the descending colon (arrow).
Laparoscopic view of the dark mass in the left lower abdomen after the mass was detached from the parietal peritoneum.
A. Intestinal hematoma
C. Epiploic appendagitis
D. Ectopic pancreas
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
Users' Guides to the Medical Literature
Clarifying Your Question
Users' Guides to the Medical Literature
Three Examples of Question Clarification
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.