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Special Feature
July 01, 2006

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Department of Surgery, Veterans Affairs Medical Center, Salem, Va.

 

GRACE S.ROZYCKIMD

Arch Surg. 2006;141(7):711-712. doi:10.1001/archsurg.141.7.711

A 37-year-old man presented with progressively worsening colicky epigastric pain that became generalized and persistent. He had a similar episode 1 week prior, which resolved spontaneously. His abdomen was mildly distended and tympanitic in the epigastrium. Plain film of the abdomen showed dilated small-bowel loops, especially in the left upper quadrant. Nasogastric drainage produced 1.5 L of feculant material. Exploratory laparotomy revealed multiple dilated small-bowel loops which were traced back to a transition point where the small bowel was seen herniating through a tight well-formed, fibrous ring (Figure).

Figure.
The small bowel herniating through a defect in the transverse colonic mesentery.

The small bowel herniating through a defect in the transverse colonic mesentery.

What Is the Diagnosis?

A. Diaphragmatic hernia

B. Congenital intra-abdominal band

C. Paraduodenal hernia

D. Intra-abdominal adhesions

E. Littre hernia

Answer

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