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Special Feature
August 1, 2006

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: Department of General Surgery, Newham University Hospital, Plaistow, London (Dr Amer), and Departments of General Surgery (Dr Johnston) and Radiology (Dr Gutmann), Old Church Hospital, Romford, Essex, England.

Arch Surg. 2006;141(8):833. doi:10.1001/archsurg.141.8.833

A 73-year-old woman came to the surgical department with acute central abdominal pain and vomiting. She had no similar attacks in the past, and her medical history was not significant. On examination, she was in pain, was dehydrated, and had a distended and tender abdomen, mainly in the left iliac fossa. Her bowel sounds were diminished, and rectal examination results were not significant. Following fluid resuscitation, a barium enema and magnetic resonance imaging were arranged (Figure 1 and Figure 2).

Figure 1.
A barium enema showed the soft indentation caused by the lipoma (arrow) of the colon in contrast to the apple-core appearance of malignant lesions.

A barium enema showed the soft indentation caused by the lipoma (arrow) of the colon in contrast to the apple-core appearance of malignant lesions.

Figure 2.
A magnetic resonance image of the colon showed intussusception. Notice the lead point caused by the well-defined high T2-weighted signal, indicating a lipoma (arrow), 9 cm from the anal verge.

A magnetic resonance image of the colon showed intussusception. Notice the lead point caused by the well-defined high T2-weighted signal, indicating a lipoma (arrow), 9 cm from the anal verge.

What Is the Diagnosis?

A. Volvulus

B. Intussusception caused by cancer

C. Intussusception caused by lipoma of the colon

D. Simple obstruction caused by a large adenoma

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