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Special Feature | November 16, 2009

Image of the Month—Quiz Case FREE

Dinesh N. Ratnapala, MB, ChB; David Lisle, FRACR; Elizabeth Munn, FRCPA; Andreas L. Lambrianides, FRACS

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Arch Surg. 2009;144(11):1087. doi:10.1001/archsurg.2009.187-a.

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A 74-year-old man was admitted to the hospital with dehydration and a 6-week history of nausea, anorexia, watery diarrhea with associated crampy abdominal pain, and weight loss. Medical history included hypertension and paroxysmal atrial fibrillation with regular medication consisting of clopidogrel bisulfate and atenolol.

On examination, the patient was in sinus rhythm, was moderately dehydrated, had right-sided abdominal tenderness, and had no organomegaly or palpable masses. Digital rectal examination results were negative for blood. Laboratory tests showed moderate leukocytosis (white blood cell count, 15 600/μL [to convert to ×10⁹per liter, multiply by 0.001]; with an elevated neutrophil count of 13 600/μL), an elevated C-reactive protein level (157 mg/L [to convert to nanomoles per liter, multiply by 9.524]), and an erythrocyte sedimentation rate of 32 mm/h. Arterial blood gas showed no lactic acidosis. Stool culture results were negative for pathogenic growth as well as for Clostridium difficiletoxin. The patient was admitted for resuscitation and investigation.

A computed tomographic scan (Figure 1) showed extensive concentric bowel wall thickening of the terminal ileum and cecum. There was also stranding in the mesenteric fat.

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Figure 1.

Computed tomographic scan of the abdomen with oral contrast material showing concentric bowel wall thickening of the terminal ileum and cecum. There was also stranding in the mesenteric fat.

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WHAT IS THE DIAGNOSIS?

A. Crohn disease

B. Nonocclusive ischemic colitis

C. Typhlitis

D. Lymphoma

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Figure 1.

Computed tomographic scan of the abdomen with oral contrast material showing concentric bowel wall thickening of the terminal ileum and cecum. There was also stranding in the mesenteric fat.

Grahic Jump Location

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

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Ratnapala DN, Lisle D, Munn E, Lambrianides AL. Image of the Month—Quiz Case. Arch Surg. 2009;144(11):1087. doi:10.1001/archsurg.2009.187-a.

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