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Special Feature
March 1, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: Mount Sinai School of Medicine, New York, NY (Ms Humbyrd and Drs Lin and Baril); and Elmhurst Hospital Center, Elmhurst, NY (Dr Kim).


Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Surg. 2007;142(3):307. doi:10.1001/archsurg.142.3.307

A 27-year-old woman presented with an acute worsening of chronic epigastric pain, which had been present since normal, spontaneous, vaginal delivery of a healthy, full-term infant 1 month previously. In the 2 days prior to admission, the patient experienced nausea; 2 episodes of bilious emesis; and frequent, small, loose stools. Physical examination showed an afebrile, stable patient in moderate distress with significant epigastric tenderness and a palpable, transverse supraumbilical mass, which measured approximately 10 × 2 cm. Laboratory findings were unremarkable. Abdominal computed tomography was performed (Figure 1) and demonstrated a soft tissue lesion involving the ascending to mid transverse colon consistent with intussusception of the ileocecal region into the transverse colon. The patient underwent resection of the involved bowel (Figure 2). She had an uneventful recovery and was discharged on the fifth postoperative day.

Figure 1.
Image not available

A computed tomographic scan of the abdomen demonstrating a soft tissue lesion consistent with intussusception of the ileocecal region into the transverse colon.

Figure 2.
Image not available

Gross pathology of the resected bowel, which contained a 5-cm, round, nonmobile mass on the ileocecal valve.

What Is the Diagnosis?

A. Small-bowel adenocarcinoma

B. Carcinoid tumor of the small bowel

C. Extranodal lymphoma, mucosa-associated lymphoid tissue (MALT) type

D. Gastrointestinal stromal tumor of the small bowel