Grace S.RozyckiMDFrom the Departments of Surgery (Drs St Peter and Heppell) and Pathology (Dr Leslie), Mayo Clinic, Scottsdale, Ariz.
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).
A.Acute mesenteric venous thrombosis
D.Inflammatory bowel disease
St Peter SD, Leslie KO, Heppell JP. Image of the Month—Quiz Case. Arch Surg. 2004;139(5):565-566. doi:10.1001/archsurg.139.5.565