RT Journal
A1 Barreiro CJ, Haut ER
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD April 1
VO 145
IS 4
SP 395
OP 395
DO 10.1001/archsurg.2010.43-a
UL http://dx.doi.org/10.1001/archsurg.2010.43-a
AB 
A 52-year-old woman presented to the emergency department with a 2-week history of sharp, intermittent periumbilical abdominal pain and low-grade fevers. Her medical and surgical histories were significant for hypertension and obesity and a lower abdominal midline laparotomy for ruptured ectopic pregnancy. An abdominal computed tomographic scan revealed a 5-cm-long radiodensity in the mid small bowel directly abutting the anterior abdominal wall with surrounding inflammation and bowel wall thickening (Figure 1). Her white blood cell count was elevated at 15 000/μL (to convert to ×109/L, multiply by 0.001), and her abdominal examination revealed voluntary guarding and periumbilical tenderness to deep palpation. The findings were concerning for small-bowel perforation, and the patient was taken to the operating room for exploratory laparotomy.