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).
B. Gallstone ileus
Corresponding author: Alberto Madrid, MD, Department of Surgery, Lyndon B. Johnson Hospital, 5656 Kelley St, Suite 30S62008, Houston, TX 77026.
Windham TC, Rascoe PA, Madrid A. Image of the Month—Quiz Case. Arch Surg. 2003;138(7):807. doi:10.1001/archsurg.138.7.807