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Special Feature
December 01, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Department of Surgery, SUNY Downstate Medical Center, Brooklyn, New York.

 

GRACE S.ROZYCKIMD

Arch Surg. 2007;142(12):1221. doi:10.1001/archsurg.142.12.1221

A 55-year-old man with no medical history presented to the emergency department with abdominal pain of 2 days' duration. The pain was localized to the epigastric region and described as intermittent and colicky in nature. The patient denied any episodes of fever, nausea, vomiting, diarrhea, constipation, or weight loss. On admission, he was afebrile with normal vital signs. Physical examination revealed an overweight man with mild abdominal tenderness in the left upper quadrant. He had no distention, no guarding, and normal bowel sounds. The results of laboratory studies were within normal limits, including complete peripheral blood cell count, blood chemical analyses, and carcinoembryonic antigen level. Fecal occult blood test results showed abnormalities, and chest radiograph findings were unremarkable. Computed tomography (CT) of the abdomen with contrast was performed, and colonoscopy revealed an obstructive mass in the transverse colon (Figure 1). The patient was taken to the operating room for a right-sided hemicolectomy with primary anastomosis.

Figure 1.
Computed tomographic scan demonstrating colocolonic intussusception of the transverse colon secondary to a 4-cm soft tissue mass.

Computed tomographic scan demonstrating colocolonic intussusception of the transverse colon secondary to a 4-cm soft tissue mass.

What Is the Diagnosis?

A.Obstructing carcinoma of the transverse colon

B.Obstructing diverticulitis

C.Crohn disease of the colon

D.Intussusception of the colon

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