Clinical Review & Education JAMA Surgery Clinical Challenge Valentino Fiscon, MD; Giuseppe Portale, MD; Paola Cusatelli, MD A B Figure. A, Abdominal computed tomography suggesting the presence of an ileal intussusception. B, Colonoscopy revealing the presence of a bulge in the cecal lumen. A woman in her 40s presented to our department with lower abdominal pain, lasting for a few weeks, with nausea and vomiting but no diarrhea or fever. Her medical history WHAT IS THE DIAGNOSIS? was unremarkable; in particular, she had no history of endometriosis. She had visited the emergency department of another hospital 2 weeks A. Appendiceal abscess before with the same symptoms and had received Quiz at jamasurgery.com conservative treatment. On physical examination in B. Ileal intussusception the present visit, she had lower abdominal tenderness but no sign of peritoneal irritation. A mass was palpable in the lower right abdominal C. Cecal volvulus quadrant. The results of routine blood investigations, including white blood cell count, hemoglobin concentration, and C-reactive protein level, were within normal limits, as they had been in the previous hospital. Abdominal ultrasonographic examination was D. Appendiceal intussusception performed, followed by abdominal computed tomography; the results were suggestive of an ileal intussusception (Figure,
JAMA Surgery – American Medical Association
Published: Jul 1, 2014
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