Image of the Month—Quiz Case | Gastroenterology | JAMA Surgery | JAMA Network
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May 2003

Image of the Month—Quiz Case

Author Affiliations

From the Department of Surgery, The Mercy Hospital of Pittsburgh, Pittsburgh, Pa.



Arch Surg. 2003;138(5):561. doi:10.1001/archsurg.138.5.561

A 65-YEAR-OLD man had a 1-week history of midepigastric pain, nausea, and vomiting. He denied any previous abdominal complaints. His medical history was significant for peripheral vascular disease, hypertension, a 2-pack-per-day smoking habit, and alcohol abuse (12 drinks per day). His physical examination was remarkable for an irregular heart rate of 124 beats/min, temperature of 38.4°C, and mild abdominal distention and tenderness, but no signs of peritonitis. His white blood cell count was 20.1 × 103µL and his sodium level was 119 mEq/L. Plain abdominal x-ray films were nonspecific.

Following aggressive fluid resuscitation and initiation of ampicillin-sulbactam and gentamycin, a computed tomographic (CT) scan of the abdomen (Figure 1) was obtained. Due to the retrogastric air-filled cavity seen on CT, he underwent celiotomy. The findings are shown in Figure 2.

What is the Diagnosis?

A. Foramen of Winslow hernia

B. Duodenal diverticulum

C. Infected pancreatic pseudocyst

D. Perforated gastric ulcer

E. Intestinal duplication cyst