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JAMA Surgery Clinical Challenge
January 2017

An Inevitable Surgical Procedure

Author Affiliations
  • 1Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
JAMA Surg. 2017;152(1):99-100. doi:10.1001/jamasurg.2016.3977

A man in his 40s was referred from jail with abdominal pain for 5 days. The pain was constant in the hypogastric region, with no radiation. He did not have bowel movements for 5 days but passed gas normally. He did not complain of nausea or vomiting. He denied substance abuse or addiction.

The abdomen was soft with hypogastric tenderness. There was no abdominal distension, guarding, or rebound tenderness. Neither hernia nor surgical scars were seen on examination, and vital signs and results from laboratory tests were normal. An axial contrast computed tomography (CT) scan of the abdomen was performed (Figure 1).

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