PMC2687895_01
Abdominal X-ray revealed distended bowel loops, with air-fluid levels.
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An abdominal X-ray showed grossly distended loops of small intestine with absent colonic shadows, suggestive of mid-bowel obstruction (Figure 1).
Contrast CT-scan showed:. A. Distended proximal bowel loops, with air-fluid levels.. B. Fat pulled into the intussusception (white arrow) adjacent to a portion of the intussusceptum.. C. Enteroenteric intussusception forming a loop within the pelvis. Intussuscipiens containing intussusceptum in longitudinal section.. D. Distal bowel loops were not dilated. Moderate amount of free fluid.
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CT-scan was recommended by the radiologist. Contrast enhanced CT-scan (Figure 2) revealed a hypodense mass lesion in the pelvis, representing a thickened segment of bowel (enteroenteric intussusception).
Laparotomy revealed:. Ileoileal intussusception. Initial point of intussusception is showed with arrow (affected by Crohn's disease). Intussusceptum bowel was necrotic with thin walls and close to perforate.
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The rest of the bowel (10 cm-long) was hemorrhagic and presented small longitudinal ulcerations with irregular borders in the mucosa (Figure 3).
Microscopy examination of the specimen (H&E, 100x):. A. Thickening of muscularis mucosae with granulomas occurs near the obstructive point.. B. Granulomas were present in the mucosa.
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Transmural inflammation, deep ulcerations, and non-necrotizing epithelioid cell granuloma (sarcoid like-granulomas) were demonstrated (Figure 4).