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Image of the Month—Quiz Case

Image of the Month—Quiz Case AN 87-YEAR-OLD man with a known history of cholelithiasis was seen in the emergency department for acute onset of abdominal pain, vomiting, and diarrhea. On examination, he was afebrile, had a distended abdomen, and was tender to palpation in the left iliac fossa. Bowel sounds were active. The abdominal computed tomographic scan is shown in Figure 1. Following unsuccessful attempts at endoscopic fragmentation/extraction, a small left iliac fossa muscle-splitting incision was performed, the stone removed (Figure 2), and a colostomy formed. Figure 1. View LargeDownload Figure 2. View LargeDownload What Is the Diagnosis? A. Diverticular stricture B. Cholecystocolic fistula and large-bowel obstruction due to gallstone ileus C. Cholecystoduodenal fistula and small-bowel obstruction due to gallstone ileus D. Obstructing colonic carcinoma Corresponding author: Gerrard O'Donoghue, AFRCSI, Department of Surgical Research, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland (e-mail: gerry8941@eircom.net). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Image of the Month—Quiz Case

Abstract

AN 87-YEAR-OLD man with a known history of cholelithiasis was seen in the emergency department for acute onset of abdominal pain, vomiting, and diarrhea. On examination, he was afebrile, had a distended abdomen, and was tender to palpation in the left iliac fossa. Bowel sounds were active. The abdominal computed tomographic scan is shown in Figure 1. Following unsuccessful attempts at endoscopic fragmentation/extraction, a small left iliac fossa muscle-splitting incision was performed, the...
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Publisher
American Medical Association
Copyright
Copyright © 2003 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.138.12.1391
Publisher site
See Article on Publisher Site

Abstract

AN 87-YEAR-OLD man with a known history of cholelithiasis was seen in the emergency department for acute onset of abdominal pain, vomiting, and diarrhea. On examination, he was afebrile, had a distended abdomen, and was tender to palpation in the left iliac fossa. Bowel sounds were active. The abdominal computed tomographic scan is shown in Figure 1. Following unsuccessful attempts at endoscopic fragmentation/extraction, a small left iliac fossa muscle-splitting incision was performed, the stone removed (Figure 2), and a colostomy formed. Figure 1. View LargeDownload Figure 2. View LargeDownload What Is the Diagnosis? A. Diverticular stricture B. Cholecystocolic fistula and large-bowel obstruction due to gallstone ileus C. Cholecystoduodenal fistula and small-bowel obstruction due to gallstone ileus D. Obstructing colonic carcinoma Corresponding author: Gerrard O'Donoghue, AFRCSI, Department of Surgical Research, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland (e-mail: gerry8941@eircom.net).

Journal

Archives of SurgeryAmerican Medical Association

Published: Dec 1, 2003

Keywords: abdominal pain,small bowel obstruction,carcinoma,diarrhea,endoscopy,pathologic fistula,gallstone ileus,calculi,palpation,surgical procedures, operative,vomiting,colostomy procedure,abdominal swelling,bowel sounds,cholecystoduodenal fistula,cholelithiasis,ilium,intestine, large,ireland,abdomen,colon,splitting - mental defense mechanism,emergency service, hospital

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