PMC2913790_01
Abdomen computed tomography after intravenous contrast. Significant thickening of the Treitz angle and proximal jejunum (arrows), with infiltration of the loco-regional fat.
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The abdomen CT with intravenous contrast disclosed a significant thickening of the wall of the third, fourth duodenum, and of the proximal part of the jejunum with infiltration of the loco-regional fat (Figure 1).
Angiography demonstrating active bleeding (arrow) in one of the branchs of the jejunal arteries.
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Angiography demonstrated that the bleeding originated from a jejunal branch and microcatheter embolization was successful initially (Figure 2).
Microscopic examination (hematoxylin-eosin, x150) of the operative specimen. Ulcerative ileitis, the mucosa is replaced by a granulation tissue.
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Histology of the jejunal resection showed a severe mucosal necrosis with loss of villi (Figure 3).
High-power microscopic examination (hematoxylin-eosin, x400) revealed vasculitis. Some endothelial cells present cytomegaly, suggestive of CMV infection (arrows). The presence of CMV in the jejunum was demonstrated by immunohistochemistry (inset; immunoperoxidase, x400).
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Some of the endothelial cells presented the characteristic cytopathogenic aspect of CMV infection (Figure 4).