TY  - JOUR
T1  - IMage of the month–quiz case
AU  - Poultsides GA, Zani S, Bloom G, Tishler DS
Y1  - 2009/03/16
N1  - 10.1001/archsurg.2008.551-a
JO  - Archives of Surgery
SP  - 287
EP  - 288
VL  - 144
IS  - 3
N2  - 
A 67-year-old woman came to the emergency department with worsening epigastric pain, bilious emesis, and obstipation during the previous 3 days. She denied having had similar symptoms in the past. She was otherwise healthy and had no history of previous abdominal operations. Physical examination revealed a soft, distended abdomen with mild epigastric tenderness. No abdominal wall hernias were noted. Laboratory studies showed leukocytosis (white blood cell count, 26.4/μL [to convert to ×109/L, multiply by 0.001]). Abdominal radiographs were significant for gastric dilatation only. Findings from computed tomography of the abdomen were suggestive of an internal hernia (Figure 1). After intravenous fluid resuscitation and nasogastric tube decompression, the patient underwent laparoscopic exploration. An internal hernia was diagnosed and repaired laparoscopically (Figure 2).

SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2008.551-a
UR  - http://dx.doi.org/10.1001/archsurg.2008.551-a
ER  -