TY - JOUR T1 - IMage of the month—quiz case AU - Kubasiak J, Linn J, Crandall M Y1 - 2011/09/01 N1 - 10.1001/archsurg.2011.241-a JO - Archives of Surgery SP - 1095 EP - 1095 VL - 146 IS - 9 N2 - Abdominal examination revealed a distended abdomen with absent bowel sounds. A mass was palpable in the upper abdomen, and peritoneal signs were present. Cardiopulmonary examination was normal. Vital signs and laboratory results showed a temperature of 38°C, white blood cell count of 22 000/μL (to convert to ×109/L, multiply by 0.001) with 92% neutrophils, hemoglobin level of 16.3 g/dL (to convert to grams per liter, multiply by 10), a total bilirubin level of 3.2 mg/dL (to convert to micromoles per liter, multiply by 17.104), and a direct bilirubin level of 0.8 mg/dL (to convert to micromoles per liter, multiply by 17.104). Computed tomographic scan with contrast of the chest and abdomen was obtained (Figure 1 and Figure 2). Fluid resuscitation was initiated. SN - 0004-0010 M3 - doi: 10.1001/archsurg.2011.241-a UR - http://dx.doi.org/10.1001/archsurg.2011.241-a ER -