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Special Feature
July 1, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Department of Surgery, University of Maryland Medical Center, and Department of Surgery, Veterans Affairs Maryland Healthcare System, Baltimore. Dr Napolitano is now with the Department of Surgery, University of Michigan Health System, Ann Arbor.

 

GRACE S.ROZYCKIMD

Arch Surg. 2007;142(7):685. doi:10.1001/archsurg.142.7.685

A 37-year-old man with Crohn disease, quiescent since an ileal resection and end ileostomy followed by elective ileostomy closure 10 years ago, came to the emergency department with a 2-month history of crampy abdominal pain in both lower quadrants associated with a weight loss of 11 kg, fevers and chills, mild nausea and vomiting, and diarrhea following a recent trip to Mexico. On examination, he had a palpable 5 × 7-cm mass in the right lower quadrant. Computed tomographic evaluation of the abdomen was performed (Figure).

Figure.
Computed tomographic scan of the abdomen.

Computed tomographic scan of the abdomen.

What Is the Diagnosis?

A. Double intussusceptions of the descending colon

B. Enterorectus fistula

C. Gastrointestinal stromal tumor of the intestine

D. Duplication cyst of the small intestine

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