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Special Feature
November 2002

Image of the Month

Author Affiliations

GRACE S.ROZYCKIMDFrom the Departments of Surgery (Dr Consorti) and Gastroenterology (Dr McGee), Kelsey-Seybold Clinic, Houston, and the Department of Surgery, University of Texas–Houston Medical School (Dr Liu). Dr Liu is now with the Department of Surgery, University of California, San Francisco–East Bay, Oakland.

Arch Surg. 2002;137(11):1311-1312. doi:

A 56-YEAR-OLD man sought treatment because of bloody stools and syncope. He underwent a transfusion and an esophagogastroduodenoscopy, which showed a hiatal hernia and mild gastritis but no source of bleeding. Results of a colonoscopy were normal. Although the bleeding spontaneously resolved, during the subsequent 2 years, he continued to have trace hemoccult-positive stools and was treated for reflux esophagitis. A routine chest radiograph demonstrated an abnormality in his mediastinum. A computed tomographic scan showed a large hiatal hernia and a 7 × 5-cm incidental mass in the abdomen (Figure 1). Subsequently, an esophagogastroduodenoscopy was performed, and it showed a submucosal mass between the third to fourth portions of the duodenum (Figure 2).

What Is the Diagnosis?

A.Duplication cyst

B.Pancreatic pseudocyst

C.Duodenal diverticulum

D.Small-bowel stromal tumor

Accepted for publication March 8, 2002.

Corresponding author and reprints: Terrence H. Liu, MD, Department of Surgery, University of California, San Francisco–East Bay, 1411 E 31st St, Oakland, CA 94602.