PMC8578821_01
(A) The initial abdominal plain film showed non-specific bowel gas distribution without abnormal calcification or free air. (B) Ultrasonography of the abdomen revealed colon dilatation with air-fluid levels and ascites.
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F1
The initial plain abdominal radiograph in Figure 1 shows a non-specific intestinal gas distribution without abnormal calcification or pneumoperitoneum.
Abdominal CT revealed much fecal impaction and colon dilatation along with colon wall thickening and pneumatosis intestinalis (arrow).
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F2
A subsequent computed tomography (CT) scan indicated a large number of fecal impactions and colon dilations, along with colon wall thickening and pneumatosis coli, as depicted in Figure 2.
(A) Exploratory laparoscopy revealed poor perfusion of the upper rectum with pericolonic fibrin and turbid ascites in the pelvic cavity. (B) The section showed ischemic change, intensive mucosal injury, and focal transmural necrosis of the large intestine (arrow). (C) The specimen showed focal ischemic change and transmural necrosis of the large intestine.
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F3
The ischemic rectum was removed, and primary anastomosis of the descending colon and rectum was performed, with a diverting loop transverse colostomy over the right quadrant of the abdomen (Figure 3). The pathology illustrated in Figure 3 showed focal ischemic changes, severe mucosal damage and focal transmural necrosis of the large intestine, which were evidence for diagnosis.