Images in Surgery

The challenge of a „zebra“ in proctology 

A 38-year old female presented to the emergency department with a one-day history of acute pain in the upper right quadrant of the abdomen, increasing within the last few hours. Her medical history included a non-alcoholic fatty liver disease with moderate hepatic fibrosis, endometriosis and hypertension.

A mystery in the bursa (Latin: bag, sac) caused moderate clinical signs yet led to major abdominal surgery. We present a diagnosis with a plethora of nonspecific symptoms that poses a diagnostic challenge for both surgeons and radiologists.

A Case of Intestinal Obstruction of Uncertain Etiology

This 58-year-old male patient with no prior medical or surgical history (no medication, no substance abuse) was sitting at dinner with his wife, when he suddenly felt epigastric pain and upon standing up, lost consciousness, fell and hit his head on the floor. He regained consciousness upon arrival of the ambulance and, except for disorientation, was neurologically not impaired.

The incidence of acute mesenteric ischaemia (AMI) is very low, accounting for approximately 0.1-0.2% of all surgical admissions (1). However, if left untreated, mortality is high at 50% (2).