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Image of the Month—Quiz Case
Min P. Kim, MD;
Yael Vin, MD, MPH;
Sareh Parangi, MD
Author Affiliations: Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Arch Surg. 2006;141:609.
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INTRODUCTION
An 85-year-old woman with dementia and multiple comorbidities had a 4-day history of vomiting. Six months prior to admission, she had cholecystitis that was treated with a cholecystostomy tube. The tube was subsequently removed when her symptoms resolved. On examination, she was afebrile with normal vital signs. She was alert but confused and had a soft, nontender, and nondistended abdomen without rebound or guarding. She had a white blood cell count of 10 500/µL, a normal amylase level, a normal lipase level, and normal liver function test results. The abdominal radiograph showed a dilated small bowel, minimal colonic air, and no obvious cause for the small-bowel dilation. A computed tomographic scan showed pneumobilia, collapsed gallbladder, dilated small bowel, and a 3 x 4-cm gallstone in the small bowel (Figure 1). The gallstone had not been visible on the . . . [Full Text of this Article]
What Is the Operation of Choice?
RELATED ARTICLE
Image of the Month—Diagnosis
Arch Surg. 2006;141(6):610.
EXTRACT
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