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Kurt R. Stahlfeld, MD; Michael Edwards; Harry W. Sell, MD
From the Department of Surgery, The Mercy Hospital of Pittsburgh, Pittsburgh, Pa.

Arch Surg. 2003;138:561.

INTRODUCTION
A 65-YEAR-OLD man had a 1-week history of midepigastric pain, nausea, and vomiting. He denied any previous abdominal complaints. His medical history was significant for peripheral vascular disease, hypertension, a 2-pack-per-day smoking habit, and alcohol abuse (12 drinks per day). His physical examination was remarkable for an irregular heart rate of 124 beats/min, temperature of 38.4°C, and mild abdominal distention and tenderness, but no signs of peritonitis. His white blood cell count was 20.1 x 10³ µL and his sodium level was 119 mEq/L. Plain abdominal x-ray films were nonspecific.

Following aggressive fluid resuscitation and initiation of ampicillin-sulbactam and gentamycin, a computed tomographic (CT) scan of the abdomen (Figure 1) was obtained. Due to the retrogastric air-filled cavity seen on CT, he underwent celiotomy. The findings are shown in Figure 2.

View larger version (57K): [in this window] [in a new window] Figure 1.

View larger version (153K): [in this window] [in a new window] Figure 2.

What is the Diagnosis?

Jump to Section  • Top  • Introduction  • What is the diagnosis?

A. Foramen of Winslow hernia

B. Duodenal diverticulum

C. Infected pancreatic pseudocyst

D. Perforated gastric ulcer

E. Intestinal duplication cyst

Answer:

SECTION EDITOR: GRACE S. ROZYCKI, MD

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Arch Surg. 2003;138(5):562.
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