RT Journal
A1 O' Donoghue GT, Winter D, Deasy J
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD December 1
VO 138
IS 12
SP 1391
OP 1391
DO 10.1001/archsurg.138.12.1391
UL http://dx.doi.org/10.1001/archsurg.138.12.1391
AB 
AN 87-YEAR-OLD man with a known history of cholelithiasis was seen in the emergency department for acute onset of abdominal pain, vomiting, and diarrhea. On examination, he was afebrile, had a distended abdomen, and was tender to palpation in the left iliac fossa. Bowel sounds were active. The abdominal computed tomographic scan is shown in Figure 1. Following unsuccessful attempts at endoscopic fragmentation/extraction, a small left iliac fossa muscle-splitting incision was performed, the stone removed (Figure 2), and a colostomy formed.