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Special Feature
May 5, 2004

Image of the Month—Quiz Case

Author Affiliations

Grace S.RozyckiMDFrom the Departments of Surgery (Drs St Peter and Heppell) and Pathology (Dr Leslie), Mayo Clinic, Scottsdale, Ariz.

Arch Surg. 2004;139(5):565-566. doi:10.1001/archsurg.139.5.565

A 77-year-old man presented after 3 days of diffuse abdominal pain, anorexia, and nausea. Four years before admission, he underwent an abdominoperineal resection for rectal cancer and was since admitted twice with episodes of partial small-bowel obstruction that resolved with conservative measures. Recently, he had developed and was treated for a urinary tract infection. In addition to his abdominal pain, he had profuse, watery stomal output. Although he wasafebrile, his white blood cell count was 50.7 ×103/µL. His abdomen was diffusely tender to deep palpation, but he exhibited no guarding or peritoneal signs. A computed tomographic scan of the abdomen showed a diffusely edematous bowel with ascites (Figure 1) and portal venous air (Figure 2).

What Is the Diagnosis?

A.Acute mesenteric venous thrombosis

B.Ischemic colitis

C.Pseudomembranous enterocolitis

D.Inflammatory bowel disease