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Special Feature
January 1, 2007

Image of the Month—Quiz Case

Author Affiliations

Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Surg. 2007;142(1):97. doi:10.1001/archsurg.142.1.97

An 87-year-old woman had acute onset of lower abdominal pain following a painful bowel movement. She had a history of diverticulitis and chronic constipation. Her medical and surgical history also included a remote history of renal cell cancer status after left nephrectomy, a hysterectomy, and steroid-dependent arthritis. On physical examination, she was afebrile and normotensive, but in moderate distress with lower abdominal tenderness and guarding. Abdominal computed tomography was performed (Figure 1and Figure 2).

Figure 1.
Computed tomographic scan of the abdomen.

Computed tomographic scan of the abdomen.

Figure 2.
Computed tomographic scan of the pelvis.

Computed tomographic scan of the pelvis.

What Is the Diagnosis?

A. Perforated diverticulitis

B. Perforated peptic ulcer

C. Perforated stercoral ulcer

D. Perforated appendicitis