Author Affiliations:Department of Surgery, Hadassah Hebrew Medical Center, Jerusalem, Israel (Drs Khalaileh, Adileh, Abu-Gazalah, Mintz, Rivkind, and Keidar); and the Department of Surgery, New York University Hospital, New York, New York (Dr Schlager).
A 70-year-old man with no surgical history presented to the emergency department with right lower quadrant pain that began acutely 1 day prior. The pain was described as colicky and progressive in nature and radiated to the midabdomen and back. The patient denied any accompanying subjective fever, nausea, or vomiting.
Physical examination demonstrated moderate tenderness over the right lumbar region. The abdomen was soft and not tender, with minimal distension. The remainder of the physical examination and results of basic laboratory tests were unremarkable. A computed tomographic scan of the abdomen and pelvis with oral and intravenous contrast demonstrated dilated loops of small bowel indicative of small-bowel obstruction, with no contrast seen passing through to the colon (Figure 1). Following computed tomography, fluid resuscitation and supportive care were initiated in preparation for surgery. However, the patient then began to report intensifying pain, and the decision was made to take the patient immediately to the operating room for a diagnostic laparoscopy. On entering the peritoneum, a small amount of serous ascites were noted as well as moderate small-bowel distension. The bowel was run from the ligament of Treitz distally. On reaching the region of the terminal ileum, we encountered the source of the site of the obstruction (Figure 2).
Computed tomographic image of the abdomen demonstrating dilated loops of small bowel with no contrast passing through to the colon, consistent with small-bowel obstruction. No clear transition point was visualized.
Intraperitoneal view of the right lower quadrant of the abdomen through a midline subumbilical port demonstrating a loop of ileum incarcerated in the cecal mesentery.
A. Small-bowel obstruction due to adhesion
B. Incarcerated paracecal hernia
C. Small-bowel volvulus
D. Cecal diverticulitis
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.
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.