Image of the Month—Quiz Case

Abstract

A 52-YEAR-OLD AFRICAN AMERICAN MAN with lactose intolerance, non–insulindependent diabetes mellitus, hypertension, and a virgin abdomen presented with a 6-week history of a 4.5-kg weight loss and a 3-month history of worsening, intermittent, colicky epigastric and periumbilical abdominal pain associated with nausea and vomiting. His pain was most intense postprandially but was relieved by vomiting. He had constipation relieved with laxatives but was passing flatus. A computed tomographic scan of the abdomen revealed a 4.5-cm ileal mass causing a high-grade partial small-bowel obstruction (Figure 1 and Figure 2). An exploratory laparotomy revealed a 5-cm mass in the proximal ileum. A 12.5-cm segment of proximal ileum was sent for pathological analysis.