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Special Feature
February 2003

Image of the Month—Quiz Case

Author Affiliations

From the Southern Medical Clinic, San Fernando, Trinidad and Tobago.



Arch Surg. 2003;138(2):225. doi:10.1001/archsurg.138.2.225

A 26-YEAR-OLD woman was admitted with a 1-week history of progressively worsening generalized abdominal pain associated with nausea and vomiting. She had multiple previous admissions for similar episodes of abdominal pain since she was 15 years old. These episodes were less severe and resolved spontaneously without a diagnosis. Her medical and social histories were unremarkable. Vital signs on admission were within reference ranges, and her abdominal examination showed diffuse tenderness but no peritonitis. A plain abdominal radiograph (Figure 1) and a single-contrast barium enema radiograph (Figure 2) are shown.

What Is the Diagnosis?

A. Sigmoid volvulus

B. Diverticulitis

C. Internal herniation of the transverse colon

D. Intussusception

Corresponding author and reprints: Adrian A. Indar, FRCS, Section of Surgery, Queens Medical Centre, Nottingham NG7 2UH, England (e-mail:

Accepted for publication October 5, 2002.