TY  - JOUR
T1  - IMage of the month—quiz case
AU  - Taras A, Martinez R
Y1  - 2009/12/21
N1  - 10.1001/archsurg.2009.200-a
JO  - Archives of Surgery
SP  - 1187
EP  - 1188
VL  - 144
IS  - 12
N2  - 
A 52-year-old man presented to the emergency department complaining of an 8-hour history of progressive, crampy, epigastric, and periumbilical abdominal pain. He reported nausea but no vomiting. He continued to pass flatus and had a normal bowel movement the day prior to admission. On presentation, the patient was afebrile with normal vital signs. Physical examination was significant for high-pitched bowel tones, mild abdominal distention, and diffuse tenderness without peritoneal signs. Laboratory studies showed leukocytosis (14 500 cells/mL) with elevated bands. Acute abdominal series showed multiple dilated small-bowel loops with air-fluid levels. Computed tomography scans of the abdomen and pelvis showed dilation of the stomach and small bowel and distal decompressed bowel in the pelvis with a transition point in the left lower quadrant. Diagnostic laparoscopy revealed a loop of distal small bowel herniating through an approximately 4-cm defect in the medial peritoneal leaflet of the sigmoid mesocolon (Figure 1and Figure 2).

SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2009.200-a
UR  - http://dx.doi.org/10.1001/archsurg.2009.200-a
ER  -