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Special Feature |

Image of the Month—Quiz Case FREE

Jorge Huaco Cateriano, MD; Kenneth W. Gow, MD
[+] Author Affiliations

Author Affiliations: General and Thoracic Surgery, Seattle Children's Hospital and the University of Washington, Seattle.


Arch Surg. 2011;146(5):629. doi:10.1001/archsurg.2011.107-a.
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A 4-year-old boy developed severe, sharp, periumbilical abdominal pain followed by 4 bouts of nonbilious emesis and a loose bowel movement. He presented to an outside emergency department where a computed tomographic scan demonstrated dilated bowel (Figure 1). After a fluid bolus and insertion of a nasogastric tube, he was transferred to our institution and brought to the operating room. Laparotomy revealed that the bowel was twisted on the mesentery. Whitish fluid was present in the abdomen (with a triglyceride level of 3607 mg/dL [to convert to millimoles per liter, multiply by 0.0113]). There was similarly whitish discoloration of the entire small-bowel mesentery that followed the lymphatic channels from the bowel to the mesentery interface (Figure 2).

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Figure 1.

Computed tomographic scan.

Graphic Jump Location

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Figure 2.

Operative image.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Tuberculosis

B. Mesenteric lymphangiomatosis

C. Midgut volvulus

D. Mesenteric lipoma

Figures

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Figure 1.

Computed tomographic scan.

Graphic Jump Location
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Figure 2.

Operative image.

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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