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Kshitij Mankad, MBBS, MRCP; Edward Hoey, MBBS, MRCP

Arch Surg. 2008;143(6):607.

INTRODUCTION
A 70-year-old woman presented with a 3-day history of vomiting and right lower abdominal pain. She described the pain as radiating to the anterior aspect of her right thigh. Her only remarkable history was a laparotomy for a perforated gastric ulcer 10 years previously. Abdominal examination revealed tenderness on deep palpation in the right lower quadrant, but no guarding or rebound was elicited. Rectal and vaginal examination results were normal. She was hemodynamically stable and apyrexial. Results of blood tests including white blood cell count, urea and electrolyte measurements, and full blood cell count were normal. Abdominal radiography showed a small-bowel obstruction. Computed tomography of the abdomen was performed because the symptoms were not settling. Figure 1 confirms the small-bowel obstruction.

View larger version (54K): [in this window] [in a new window] [as a PowerPoint slide]   Figure 1. Axial computed tomography shows a small-bowel obstruction.

What Is the Diagnosis?

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A. Paralytic ileus

B. Obturator hernia

C. Bowel adhesions

D. Femoral hernia

Answer

Author Affiliations: Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, England.

SECTION EDITOR: GRACE S. ROZYCKI, MD, MBA

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Arch Surg. 2008;143(6):608.
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