PMC5851328_01
Abdominal computed tomography (CT) scan taken again after the patient showed the peritoneal irritation sign, revealing an increased CT value of the greater omentum (*) and ascites ( ). However, no infectious focus or neoplasms are observed.
CRIS2018-6145903.001.jpg
PMC5851328_01_CRIS2018-6145903.001.jpg
fig1
The CT scan showed an increased CT value of the greater omentum and ileocolic mesentery, and ascites (Figure 1).
Diffuse redness and swelling of the greater omentum is shown, and ascites are present with minimal blood dominantly in the Douglas fossa and right paracolic gutter.
CRIS2018-6145903.002.jpg
PMC5851328_01_CRIS2018-6145903.002.jpg
fig2
Laparotomy revealed diffuse redness and swelling of the greater omentum and pale haemorrhagic ascites (Figure 2).
Mononuclear cell and neutrophil infiltration to the perivascular and vascular walls. (a) Vessel wall destruction is more severe in the vein than in the artery. (b) The vessels are surrounded by epithelioid granuloma and multinucleated giant cells. (c) Palisading granuloma is seen.
CRIS2018-6145903.003.jpg
PMC5851328_01_CRIS2018-6145903.003.jpg
fig3
Histological examination of the resected omentum demonstrated both arteritis and more severe venulitis, focal necrotizing vasculitis of the venules, and palisading granuloma (Figures 3(a) and 3(c)).