PMC3414004_01
Pneumoperitoneum near the hypogastric region (a); with parietal pneumatosis of the caecum and sigmoid, compatible with acute ischemia (b).
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fig1
Abdominal CT scan revealed a pneumoperitoneum near the hypogastric region (Figure 1(a)) with parietal pneumatosis of the caecum and sigmoid, compatible with acute ischemia (Figure 1(b)).
An emergency laparotomy revealed intestinal and colonic necrosis which necessitated a 100 cm resection of the terminal ileum and subtotal colectomy with terminal ileostomy (a). An abundant quantity of nonpurulent but foul-smelling fluid was recovered during the surgery. Thick yellowish membranes covering all intra-abdominal organs were also noticed during surgery (b).
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fig2
An emergency laparotomy revealed intestinal and colonic necrosis which necessitated a 100 cm resection of the terminal ileum and subtotal colectomy with terminal ileostomy (Figure 2(a)). An abundant quantity of nonpurulent but foul-smelling fluid was recovered during the surgery but without any frank fecal peritonitis (Figure 2(b)).
An abdominal CT scan documented a lack of enhancement of the distal portion of the small bowel, including the ileostomy, compatible with ischemia (a). Numerous splenic, hepatic, and renal infarcts were visible (b and c).
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fig3
An abdominal CT scan documented a lack of enhancement of the distal portion of the small bowel, including the ileostomy, compatible with ischemia (Figure 3(a)). Numerous splenic, hepatic, and renal infarcts were visible (Figure 3(b)).
Pathological examination (H&E stain) of the colon showed diffuse active and chronic inflammatory infiltrate with extensive necrosis; broad nonseptate hyphae with irregular branching typical of mucormycosis are present (arrow) within this infiltrate and invade blood vessel walls.
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fig4
Pathological material sent during the first surgery (appendix, colon, omentum, and intra-abdominal fibrin) all showed broad nonseptate hyphae with irregular branching typical of mucormycosis invading blood vessels (Figure 4).
Photomicrograph of sporangiophores and mature azygospores.
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fig5
Microscopic examination revealed large and mostly nonseptate hyphae, rhizoids, short unbranched and brown sporangiophores up to 500 mum in length, spherical sporangia, ovoidal sporangiospores 4-7 mum long, occasional chlamydospores, and numerous pale to dark brown azygospores (Figure 5).