Case 167

 A seventy nine-year-old male presented in our hospital for abdominal pain, fever and diarrhea. Two days before, he felt lower abdomen fulness and fever of 37.5 to 38.0°C. Two years ago, he had received surgical resection of two thirds of stomach in the university hospital. Last year, he had undergone conservative treatment for adhesive ileus in our hospital.  
Laboratory test revealed white blood cells 10570/mm³, CRP 20.07 mg/dL, total bilirubin 2.6 mg/dL, hemoglobin 11.2 g/dL.  
He agreed to take non-enhanced CT (Figs 1, 2, 3) and two hours later, enhanced CT (Figs 4, 5, 6).

What is your diagnosis ?

1.　Adhesive ileus

2.　Strangulated ileus

3.　Colon diverticulitis

4.　Appendicitis

5.　Internal hernia

answer

2019.10.30