A 40-year-old woman presented to the emergency department with increasingly sharp abdominal pain in the left lower quadrant of 10 days' duration. Bowel movements were normal, the patient was afebrile, and blood test results, including a white blood cell count, were unremarkable. The physical examination showed localized pressure and percussion pain in the left lower abdomen. The patient reported that the same pain had appeared sporadically over the past 3 years, approximately twice a month and mostly during the night. She had been examined several times by a gynecologist without any pathologic findings. In addition, she had undergone a colonoscopy that revealed no abnormal findings.
In our emergency department, multislice computed tomography (CT) of the abdomen was performed after oral and intravenous administration of contrast agents. The CT scan showed thickening of the peritoneum and oval fat densities immediately adjacent to the descending colon, with surrounding edema and stranding (Figure 1). On laparoscopic exploration, a dark mass was apparent in the left lower abdomen, next to the descending colon. The mass was easily detached from the parietal peritoneum (Figure 2).
Abdominal computed tomography shows thickening of the peritoneum and localized pericolonic fat stranding next to the descending colon (arrow).
Laparoscopic view of the dark mass in the left lower abdomen after the mass was detached from the parietal peritoneum.
A. Intestinal hematoma
C. Epiploic appendagitis
D. Ectopic pancreas
Kirchhoff P, Viehl CT, Heizmann O, Oertli D, Potthast S. Image of the Month—Quiz Case. Arch Surg. 2009;144(6):587-588. doi:10.1001/archsurg.2009.62-a