RT Journal
A1 Poultsides GA, Zani S, Bloom G, Tishler DS
T1 IMage of the month–quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2009
FD March 16
VO 144
IS 3
SP 287
OP 288
DO 10.1001/archsurg.2008.551-a
UL http://dx.doi.org/10.1001/archsurg.2008.551-a
AB 
A 67-year-old woman came to the emergency department with worsening epigastric pain, bilious emesis, and obstipation during the previous 3 days. She denied having had similar symptoms in the past. She was otherwise healthy and had no history of previous abdominal operations. Physical examination revealed a soft, distended abdomen with mild epigastric tenderness. No abdominal wall hernias were noted. Laboratory studies showed leukocytosis (white blood cell count, 26.4/μL [to convert to ×109/L, multiply by 0.001]). Abdominal radiographs were significant for gastric dilatation only. Findings from computed tomography of the abdomen were suggestive of an internal hernia (Figure 1). After intravenous fluid resuscitation and nasogastric tube decompression, the patient underwent laparoscopic exploration. An internal hernia was diagnosed and repaired laparoscopically (Figure 2).