RT Journal
A1 Khalaileh A, Adileh M, Schlager A, et al
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2009
FD October 1
VO 144
IS 10
SP 975
OP 976
DO 10.1001/archsurg.2009.171-a
UL http://dx.doi.org/10.1001/archsurg.2009.171-a
AB 
Physical examination demonstrated moderate tenderness over the right lumbar region. The abdomen was soft and not tender, with minimal distension. The remainder of the physical examination and results of basic laboratory tests were unremarkable. A computed tomographic scan of the abdomen and pelvis with oral and intravenous contrast demonstrated dilated loops of small bowel indicative of small-bowel obstruction, with no contrast seen passing through to the colon (Figure 1). Following computed tomography, fluid resuscitation and supportive care were initiated in preparation for surgery. However, the patient then began to report intensifying pain, and the decision was made to take the patient immediately to the operating room for a diagnostic laparoscopy. On entering the peritoneum, a small amount of serous ascites were noted as well as moderate small-bowel distension. The bowel was run from the ligament of Treitz distally. On reaching the region of the terminal ileum, we encountered the source of the site of the obstruction (Figure 2).