SAGES Web Quiz #17 -- September 1999

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The patient is a 61 year old male with a 5 year history of crampy periumbilical pain with occasional nausea and abdominal distention. The episodes are sporadic with normalization within one to two days. There is no weight loss, fever, or change in bowel movements. There is no history of previous surgery, and the patient takes no medication. Physical examination reveals a thin, but well-nourished, well-developed male in no acute distress. There was a palpable fullness in the left epigastrium, which was somewhat fixed and non-tender.

The radiological appearance of this small bowel series is suggestive of:

a) Adenocarcinoma of the small bowel
b) Lymphoma
c) Perforated small bowel diverticulitis
d) Retractile mesenteritis (panniculitis)
e) Crohn's disease of the small bowel
f) Don't Know

This is a 30-degree laparoscopic view of the lesion.

a) The large bowel is adherent to the lesion.
b) An abscess is present.
c) The small intestine is adhered to the lesion
d) Biopsy is contraindicated.
e) Don't Know

Proper management of this lesion in this patient is:

a) Resection and primary anastomosis.
b) Biopsy and medical management.
c) Jejunojejunostomy to bypass the obstruction.
d) Subtotal colectomy.
e) Don't Know

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