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Special Feature
July 2003

Image of the Month—Quiz Case

Author Affiliations

From the Department of Surgery, University of Texas[[ndash]]Houston (Drs Windham and Rascoe); and the University of Surgery, Lyndon B. Johnson Hospital (Dr Madrid), Houston, Tex.



Arch Surg. 2003;138(7):807. doi:10.1001/archsurg.138.7.807

A 64-YEAR-OLD diabetic, hypertensive, obese woman came to the emergency department with a 5-day history of diffuse abdominal cramps. Two weeks prior, she reported an episode of acute right upper quadrant pain lasting a few hours and associated with nausea and vomiting. She had watery diarrhea during the last 2 days and 1 episode of nonbilious emesis the morning of admission. Her abdomen was soft and nontender but moderately distended. The findings on rectal examination were unremarkable. Further testing was performed (Figure 1).

What Is the Diagnosis?

A. Fecalith

B. Gallstone ileus

C. Bezoar

D. Volvulus

Corresponding author: Alberto Madrid, MD, Department of Surgery, Lyndon B. Johnson Hospital, 5656 Kelley St, Suite 30S62008, Houston, TX 77026.