An 87-year-old woman had acute onset of lower abdominal pain following a painful bowel movement. She had a history of diverticulitis and chronic constipation. Her medical and surgical history also included a remote history of renal cell cancer status after left nephrectomy, a hysterectomy, and steroid-dependent arthritis. On physical examination, she was afebrile and normotensive, but in moderate distress with lower abdominal tenderness and guarding. Abdominal computed tomography was performed (Figure 1and Figure 2).
Computed tomographic scan of the abdomen.
Computed tomographic scan of the pelvis.
A. Perforated diverticulitis
B. Perforated peptic ulcer
C. Perforated stercoral ulcer
D. Perforated appendicitis
Kim JY, Goetz L. Image of the Month—Quiz Case. Arch Surg. 2007;142(1):97. doi:10.1001/archsurg.142.1.97