PMC3573795_01
Axial image from the contrast-enhanced CT scan. A gourd-shaped, fluid-filled structure with thickened wall (arrow) was located posterior to the bladder.
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F1
Further evaluation with computed tomography (CT) scans showed localized bowel dilation, a 62 x 43 mm cystic mass and some ascites (fig. 1).
Diagnostic laparoscopy revealed a twisted, dark-colored MD in the pelvis.
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F2
Laparoscopy revealed that the patient's peritoneal cavity was filled with bloody fluid and that a black, axially torsed, gangrenous MD, measuring 6 cm in length with a 2 cm base, was located 70 cm proximal to the end of the ileum (fig. 2).
The giant gangrenous MD (hash) was exteriorized and untwisted extracorporeally via the umbilical incision (asterisk).
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F3
The MD was untwisted and wedge resection was performed (fig. 3).