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Special Feature
June 1, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Division of Emergency Non-Trauma Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, and Los Angeles County and University of Southern California Medical Center.



Arch Surg. 2007;142(6):571. doi:10.1001/archsurg.142.6.571

A 70-year-old Hispanic woman presented with severe diffuse abdominal pain and distention. Associated symptoms included nausea, vomiting, and obstipation. She reported normal bowel movements prior to admission. There was no history of surgeries or hernias. On examination, she was afebrile with normal vital signs and moderate abdominal distention with tenderness. No guarding, rebound, palpable masses, or hernias were noted. A computed axial tomography (CAT) scan of the abdomen showed a segment of edematous small bowel inferior to the inguinal ligament and lateral to the bony pelvis with proximal dilatation and distal bowel collapse consistent with a high-grade obstruction. There was no free intraperitoneal gas; however, a small amount of free fluid within the pelvis was identified (Figure 1).

Figure 1. 
Computed axial tomography scan demonstrates a thickened loop of bowel.

Computed axial tomography scan demonstrates a thickened loop of bowel.

What Is the Diagnosis?

A. Femoral hernia

B. Psoas abscess

C. Obturator hernia

D. Femoral artery aneurysm