PMC5350498_01
Initial computed tomography (CT) abdomen and pelvis scan findings on patient presentation.
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A stat computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast was suggestive of an acute obstruction of the sigmoid colon (Fig. 1).
Intraoperative findings and gross appearance of colon.
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Upon exposure, an extremely large colon was noted (including ascending, transverse, descending, and sigmoid colon) (Fig. 2).
Hematoxylin and Eosin (H&E) stain histopathological slides representing normal colon and atrophic visceral myopathy at 2x, 10x, and 20x magnification.
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Ganglion cells and the myenteric plexus appeared normal in unaffected wall, and no fibrosis was noted (Fig. 3).
Select abdominal plain films representing continued diffuse dilation of bowel in the postoperative period consistent with adynamic ileus.
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He had a prolonged postoperative course with slow return of bowel function, requiring parenteral nutrition support until postoperative day fourteen (See Fig. 4).
Chart demonstrating patient's acutely elevated serum thyroid stimulating hormone (TSH) and decreased serum free T4 at the time of intestinal pseudo-obstruction.
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Of note, patient's levothyroxine was increased in dosage during his hospital course due to an elevated TSH (see Fig. 5).