A 20-YEAR-OLD, emaciated man came to the emergency department with recurrent right lower quadrant pain and diarrhea. The patient had been having similar episodes for the past 5 years and was seen in several hospitals. He had recently been referred to a psychiatrist for these symptoms. A physical examination revealed a thin, cachectic individual, underdeveloped for his age, with tenderness in the right lower quadrant without peritoneal signs. A vague "fullness" was appreciated in the right upper quadrant. Laboratory results were within normal limits. A computed tomographic scan was obtained (Figure 1).
A. Acute intussusception
B. Cecal volvulus
C. Appendiceal abscess
D. Cecal carcinoma
Corresponding author: Rao R. Ivatury, Department of Surgery, Virginia Commonwealth University Health System, 1200 E Broad St W15E, Richmond, VA 23298.
Ivatury RR. Image of the Month—Case. Arch Surg. 2003;138(6):681. doi:10.1001/archsurg.138.6.681