TY - JOUR T1 - IMage of the month—quiz case AU - Kondo H, Adachi K Y1 - 2012/04/01 N1 - 10.1001/archsurg.2011.808a JO - Archives of Surgery SP - 389 EP - 390 VL - 147 IS - 4 N2 - A 76-year-old man with a 2-year history of chronic intermittent epigastric pain presented to our hospital. He was afebrile and had a few episodes of nausea and vomiting. His medical history was unremarkable with no previous abdominal surgery. Laboratory and physical test results revealed no abnormalities. An abdominal computed tomographic scan with intravenous contrast showed a cluster of small intestinal loops in the right upper abdomen and anterolateral displacement of the superior mesenteric artery and vein in the free edge of the hernia sac (Figure 1A). Subsequently, upper gastrointestinal contrast studies also demonstrated a circumscribed ovoid mass containing the small intestine loop in the sac (Figure 1B). The patient refused surgery at that time because his symptoms spontaneously disappeared. One year later, he developed severe colicky abdominal pain and was vomiting. An emergency laparotomy was performed. SN - 0004-0010 M3 - doi: 10.1001/archsurg.2011.808a UR - http://dx.doi.org/10.1001/archsurg.2011.808a ER -