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Image of the Month—Quiz Case
R. Ramesh Singh, MD;
Patrick Warren, MD;
Philip Smith, MD;
Wayne Wilson, MD
Author Affiliations: Department of Surgery, Veterans Affairs Medical Center, Salem, Va.
Arch Surg. 2006;141:711.
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INTRODUCTION
A 37-year-old man presented with progressively worsening colicky epigastric pain that became generalized and persistent. He had a similar episode 1 week prior, which resolved spontaneously. His abdomen was mildly distended and tympanitic in the epigastrium. Plain film of the abdomen showed dilated small-bowel loops, especially in the left upper quadrant. Nasogastric drainage produced 1.5 L of feculant material. Exploratory laparotomy revealed multiple dilated small-bowel loops which were traced back to a transition point where the small bowel was seen herniating through a tight well-formed, fibrous ring (Figure).
Figure appears in full text version.
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Figure. The small bowel herniating through a defect in the transverse colonic mesentery.
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What Is the Diagnosis?
A. Diaphragmatic hernia
B. Congenital intra-abdominal band
C. Paraduodenal hernia
D. Intra-abdominal adhesions
E. Littre hernia
Answer
SECTION EDITOR: GRACE S. ROZYCKI, MD
RELATED ARTICLE
Image of the Month—Diagnosis
Arch Surg. 2006;141(7):712.
EXTRACT
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