RT Journal
A1 Ivatury RR
T1 IMage of the month—case
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD June 1
VO 138
IS 6
SP 681
OP 681
DO 10.1001/archsurg.138.6.681
UL http://dx.doi.org/10.1001/archsurg.138.6.681
AB 
A 20-YEAR-OLD, emaciated man came to the emergency department with recurrent right lower quadrant pain and diarrhea. The patient had been having similar episodes for the past 5 years and was seen in several hospitals. He had recently been referred to a psychiatrist for these symptoms. A physical examination revealed a thin, cachectic individual, underdeveloped for his age, with tenderness in the right lower quadrant without peritoneal signs. A vague "fullness" was appreciated in the right upper quadrant. Laboratory results were within normal limits. A computed tomographic scan was obtained (Figure 1).