CASE
The patient is a 34-year-old woman who has been seeing you about chronic pelvic pain for some time now. You have performed a thorough workup. You have ruled out fibroids, endometriosis, and inflammation, but you cannot seem to find a source for the patient's pain. There is no evidence of bowel disease, such as Crohn's disease, or of appendicitis. Findings from previous pelvic examinations and Pap smears have been normal, except for mild ovarian tenderness. The patient is not pregnant but has two living children. Pelvic sonograms have been unremarkable.
You decide to order CT of the abdomen and pelvis with oral and IV contrast enhancement. CT can show abnormalities of the bowel; some vascular abnormalities; free fluid or air; abnormalities of the liver, spleen, or kidneys; and, in some cases, adnexal masses. This patient's CT study is shown in Figure 1. What does it reveal?
