An Unusual Case of Abdominal Pain and Diarrhea

Question: A 46-year-old woman with a background of primary hyperparathyroidism was referred by her endocrinologist for colonoscopy for a 5-month history of diarrhea and right-sided abdominal pain. She reported sudden onset of abdominal pain with watery stools since a holiday in Lanzarote, Spain. Her past medical history consisted of a vaginal hysterectomy 2 years ago followed by tension-free vaginal tape procedure for stress incontinence. Pertinent results are as follows: hemoglobin, 126 g/L; C-reactive protein, 1; and albumin, 37. Figures A–C are endoscopic images from the posterior wall of the mid-ascending colon. What is the diagnosis? Look on page 297 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.