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Special Feature
August 2003

Image of the month—quiz case

Author Affiliations

From the Department of Surgery, University of Vermont College of Medicine, Burlington.



Arch Surg. 2003;138(8):913. doi:10.1001/archsurg.138.8.913

A 49-year-old man was referred to our institution with a diagnosis of proximal small-bowel obstruction. he had a 5-day history of worsening periumbilical and epigastric abdominal pain followed by progressive nausea and vomiting. the emesis was dark green in color and showed no evidence of blood. he had copious watery diarrhea and revealed a 2-year history of watery diarrhea. he was treated in the past for peptic ulcer disease but was not taking medications. an abdominal computed tomographic scan from the referringhospital revealed diffuse thickening of the duodenum and proximal jejunum; however, the lumen was patent, and contrast flowed readily into the distal bowel. upper endoscopy revealed large hypertrophic folds in the stomach that involved the body and fundus but not the antrum (Figure 1). the duodenum and proximal jejunum were very edematous, with multiple ulcers (Figure 2).

What is the diagnosis?

A. Helicobacter pylori infection

B. crohn disease

C. zollinger-ellison syndrome

D. lymphoma

Corresponding author and reprints: james c. hebert, md, university of vermont, fletcher house, 111 colchester ave, burlington, vt 05401 (e-mail: