Images in Clinical Medicine
Small-Bowel Obstruction
N Engl J Med 2008; 358:1381March 27, 2008
- Article
A 72-year-old woman presented with a 2-day history of abdominal pain associated with nausea and vomiting. Over the previous 10 years, she had had progressive Alzheimer's disease, requiring her to live in a long-term care facility. On physical examination, there were no abdominal scars or umbilical, inguinal, or femoral hernias. Laboratory tests revealed a normal white-cell count, and an abdominal radiologic examination was suggestive of a complete small-bowel obstruction (Panel A). Computed tomography showed small-bowel obstruction by an intraluminal mass (Panel B, arrow). This mass had a hyperdense periphery and an aerated core. During laparotomy, an enterotomy was performed and a plastic ball was found within the lumen. The ball was 4 cm in diameter and had a hard plastic layer and a soft core. Additional questioning did not reveal whether the ingestion had been voluntary or accidental or when it might have occurred. The patient had an uneventful recovery.
Fabrice Dedouit, M.D.
Philippe Otal, M.D.
Centre Hospitalier Universitaire Rangueil, 31059 Toulouse, CEDEX 9, France
dedouit.f@chu-toulouse. fr
