TY  - JOUR
T1  - IMage of the month—quiz case
AU  - Pappou EP, Velopulos C, Fishman EK, Haut ER
Y1  - 2012/11/01
N1  - 10.1001/archsurg.2011.2043a 10.1001/archsurg.2011.2043b
JO  - Archives of Surgery
SP  - 1065
EP  - 1065
VL  - 147
IS  - 11
N2  - 
A 49-year-old woman presented to the emergency department with a 2-day history of epigastric pain and malfunctioning of her peritoneal dialysis (PD) catheter. Her medical history was significant for sarcoidosis, end-stage renal disease secondary to focal segmental glomerulosclerosis associated with sarcoidosis, and hypertension. Her surgical history included a failed live-donor renal transplant and open and laparoscopic PD catheter placements. She had been on continuous ambulatory PD (CAPD) without any complications for a year since her last catheter had been placed. Her daily medications included prednisone, metoprolol succinate, nifedipine, clonidine hydrochloride, and multivitamins. Physical examination revealed a well-healed hockey stick scar in the right lower quadrant from her previous renal transplant, a well-healed infraumbilical scar from her laparoscopic PD catheter placement, and an obvious defect in the right paramedian portion of her upper abdomen underlying a previous incision, containing a mass and a palpated cordlike structure. Laboratory tests showed elevated levels of serum creatinine (9.9 mg/dL; reference range, 0.5-1.2 mg/dL; to convert to micromoles per liter, multiply by 88.4) and blood urea nitrogen (52 mg/dL; reference range, 7-22 mg/dL; to convert to millimoles per liter, multiply by 0.357). Computed tomography with intravenous contrast demonstrated a 3.1 × 2.0-cm right paramedian hernia (Figure 1).

SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2011.2043a 10.1001/archsurg.2011.2043b
UR  - http://dx.doi.org/10.1001/archsurg.2011.2043a 10.1001/archsurg.2011.2043b
ER  -