Soft-tissue case 41. Presentation
=================================

* S.S.M. Ng
* P.B.S. Lai
* J.F.Y. Lee
* W.Y. Lau

A 78-year-old woman, whose medical history included right hip fracture, dementia and hypertension, presented with repeated vomiting of undigested food for 1 day. There was no abdominal pain or diarrhea. Physical examination revealed a soft, nondistended abdomen. The serum bilirubin level was normal, but the alkaline phosphatase level was elevated (178 U/L). A plain abdominal film was obtained at the time of admission to hospital (Fig. 1). What abnormalities are demonstrated on this radiograph? The patient was treated conservatively, but the symptoms did not improve. A water-soluble contrast study was carried out subsequently (Fig. 2).

![FIG. 1](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/44/5/336/F1.medium.gif)

[FIG. 1](http://canjsurg.ca/content/44/5/336/F1)

FIG. 1 

![FIG. 2](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/44/5/336/F2.medium.gif)

[FIG. 2](http://canjsurg.ca/content/44/5/336/F2)

FIG. 2 

What is the diagnosis, and how should this patient be managed?

For the diagnosis and discussion, see page 364.

## Footnotes

*   Section Editor: Lawrence A. Stein, MD

*   Submissions to Radiology for the Surgeon, soft-tissue section, should be sent to Dr. Lawrence A. Stein, Department of Radiology, Royal Victoria Hospital, 687 Pine Ave. W, Montreal QC H3A 1A1.