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Shawn D. St Peter, MD; Kevin O. Leslie, MD; Jacques P. Heppell, MD
From the Departments of Surgery (Drs St Peter and Heppell) and Pathology (Dr Leslie), Mayo Clinic, Scottsdale, Ariz.

Arch Surg. 2004;139:565.

INTRODUCTION
A 77-year-old man presented after 3 days of diffuse abdominal pain, anorexia, and nausea. Four years before admission, he underwent an abdominoperineal resection for rectal cancer and was since admitted twice with episodes of partial small-bowel obstruction that resolved with conservative measures. Recently, he had developed and was treated for a urinary tract infection. In addition to his abdominal pain, he had profuse, watery stomal output. Although he wasafebrile, his white blood cell count was 50.7 x10³/µL. His abdomen was diffusely tender to deep palpation, but he exhibited no guarding or peritoneal signs. A computed tomographic scan of the abdomen showed a diffusely edematous bowel with ascites (Figure 1) and portal venous air (Figure 2).

View larger version (63K): [in this window] [in a new window] Figure 1.

View larger version (71K): [in this window] [in a new window] Figure 2.

What Is the Diagnosis?

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

A. Acute mesenteric venous thrombosis

B. Ischemic colitis

C. Pseudomembranous enterocolitis

D. Inflammatory bowel disease

Answer

SECTION EDITOR: GRACE S. ROZYCKI, MD

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Image of the Month—Diagnosis
Arch Surg. 2004;139(5):566.
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