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OpenAthens Shibboleth
Special Feature
Mar 2012

Image of the Month—Quiz Case

Author Affiliations


Author Affiliations: Department of Surgery, Tokyo Metropolitan Tama Medical Center (Dr Adachi) and Department of Pediatrics, Tokyo Metropolitan Fuchu Hospital (Dr Yokoro), Tokyo, Japan.

Arch Surg. 2012;147(3):293. doi:10.1001/archsurg.2011.709a

A previously healthy 14-year-old boy visited our hospital with epigastric pain, abdominal distention, nausea, and vomiting after a large meal. He denied fever or lymphadenopathy. His medical history was unremarkable. Physical examination disclosed moderate abdominal distention and minimal epigastric tenderness. The results of relevant laboratory tests were within normal ranges. A plain radiograph of the abdomen demonstrated a dilated small bowel in the upper abdomen without pneumoperitoneum. Subsequently, coronal imaging on an abdominal computed tomographic (CT) scan was obtained (Figure 1). On the basis of our findings, he underwent emergency laparotomy (Figure 2).

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Figure 1. Coronal imaging on an abdominal computed tomographic scan.

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Figure 2. Finding at laparotomy.

What Is the Diagnosis?

A.  Internal hernia caused by right-sided paraduodenal hernia

B.  Internal hernia through foramen of Winslow

C.  Volvulus of the stomach

D.  Intestinal duplication