An Unusual Cause of Ischemic Change of Long Segment of Colon Ming-Chang Ku, 1,2 Victor C. Kok, 3,4 and Chien-Kuan Lee 5 1 Department of Radiology, Kuang Tien General Hospital, Taichung, 2 Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, 3 Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, 4 Department of Bioinformatics and Medical Engineering, Asia University, Taichung, 5 Department of Pathology, Kuang Tien General Hospital, Taichung, Taiwan Question: A 53-year-old man presented to the emergency department with 2 hours of upper abdominal pain. Vital signs were unremarkable. He had no underlying disease, but had taken some unknown Chinese herbs for 1 year. Physical examination revealed palpation tenderness over the upper gastric and the right abdominal area associated with rebounding pain. Pertinent laboratory values revealed a white blood cell count of 13,270/mm 3 . The emergency physician then arranged an abdominal computed tomography (CT). What is your diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Conflicts of interest The authors disclose no conflicts. © 2017 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2016.09.063 Gastroenterology 2017;152:e12–e13 ELECTRONIC CLINICAL CHALLENGES AND IMAGES IN GI