PMC9759974_01
(A) Axial post-contrast image of the abdomen showing short segment marked wall thickening of small bowel loop in the left upper quadrant (proximal part of ileal loop) with luminal narrowing and proximal bowel distension and shouldering (white thick arrow). (B) Axial post-contrast image of the abdomen showing focal luminal narrowing (constriction) in the proximal ileal loop (white thin arrow). (C) Axial post-contrast image of the abdomen showing long segment symmetric wall thickening of distal ileal loop with homogeneous contrast enhancement (dark thick arrow). Small mesenteric lymph nodes are seen in the left side with adjacent fat stranding and internal hypoattenuation representing necrosis (white arrow head). (D) Coronal post-contrast image of the abdomen showing short segment marked wall thickening of small bowel loop in the left upper and lower quadrant (proximal part of ileal loop) with luminal narrowing and proximal bowel distension and shouldering (white thick arrow). (E) Coronal post-contrast image of the abdomen showing focal luminal narrowing (constriction) in the proximal ileal loop (white thin arrow). (F) Coronal post-contrast image of the abdomen showing long segment symmetric wall thickening of distal ileal loop with homogeneous contrast enhancement (dark thick arrow).
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Small mesenteric lymph nodes were noted in the left lower quadrant small bowel mesentery with adjacent mesenteric fat stranding and internal hypoattenuation in keeping with central necrosis (see Figure 1). 
The resected segment, the small artery forceps are pointing at the sites of constrictions.
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So we did segmental resection and end-to-end ileo-ileal anastomosis (See Figures 2 and 3).
The same picture with Figure 2 but a different view.
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So we did segmental resection and end-to-end ileo-ileal anastomosis (See Figures 2 and 3).
Gross picture 1: Resected segment of small bowel: grey white to grey brown outer surface with areas of constrictions (blue Arrows).
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That was histomorphologically consistent with Tuberculosis (See Figures 4-9).
Gross Picture 2: Opened up bowel segment at the areas of constrictions to show areas of hypertrophic mucosa with near total lumen obstruction (blue arrows) and mucosal ulcer (white arrow).
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That was histomorphologically consistent with Tuberculosis (See Figures 4-9).
Microphotograph 1: Low power view: Section taken from ulcerated mucosa showing intense inflammation and a granuloma (white arrows).
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That was histomorphologically consistent with Tuberculosis (See Figures 4-9).
Microphotograph 2: High power view: Section taken from ulcerated mucosa showing intense inflammation and a central area of caseous necrosis (white arrow) and multinucleated giant cell (yellow arrow).
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That was histomorphologically consistent with Tuberculosis (See Figures 4-9).
Microphotograph 3: High power view: Section taken from the walls of constricted segments showing intense inflammation and area of caseous necrosis (white arrow) and multinucleated giant cells (Langhans type) (yellow arrows).
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That was histomorphologically consistent with Tuberculosis (See Figures 4-9).
Microphotograph 4: Low power view: Section taken from mesenteric lymph node showing a granuloma (nodule indicated by the white arrow) with central necrosis (yellow arrow).
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That was histomorphologically consistent with Tuberculosis (See Figures 4-9).