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JAMA Surgery Clinical Challenge
October 4, 2017

Man With Mesenteric Ulceration

Author Affiliations
  • 1Department of Surgery, University Hospital Limerick, Limerick, Ireland
JAMA Surg. Published online October 4, 2017. doi:10.1001/jamasurg.2017.3846

A 48-year-old man presented to the emergency department with a 1-week history of worsening right lower quadrant tenderness and fullness. This was associated with diarrhea, vomiting, fevers, and chills. He reported some relief of symptoms with loperamide. He denied any history of weight loss, melena, or hematochezia. Other than a previous open hemorrhoidectomy, the patient had no significant medical history. Of note, he had no family history of intestinal disease.

On examination, he had a fever with a temperature of 39°C and tachycardia with a heart rate of 102 beats per minute. On abdominal examination, there was localized tenderness with guarding and fullness in the right lower quadrant. Results from his blood laboratory investigations demonstrated leukocytosis, with white blood cell count of 17 000/µL (to convert to ×109/L, multiple by 0.001) and a C-reactive protein level of 205 mg/L (to convert to nmol/L, multiple by 9.524). However, given the clinical history, the patient underwent a computed tomographic (CT) scan of the abdomen and pelvis with intravenous contrast (Figure 1). He then underwent an exploratory laparotomy.

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