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A 70 year old female presented with a four week history of epigastric pain, nausea, bilious vomiting, and weight loss of 20 lb. Forty years ago she had undergone a proctocolectomy for familial adenomatous polyposis (FAP). On examination she was apyrexial, tachycardic (120), normotensive, and dehydrated. Her abdomen was soft with a succussion splash. She was initially rehydrated and her stomach was decompressed with a nasogastric tube. She then underwent a computed tomography scan.
What is the abnormality marked with the arrows in fig 1? What is the diagnosis and management?
See page 977 for answer
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Robin Spiller, Editor
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