PMC3263066_01
(a) Ultrasound image showing the echogenic mesenteric fat (arrow) within the intussusception. (b) Non-contrast enhanced CT scan image shows findings suggestive of an intussusception. The mesenteric fat around the intussusceptum is seen entering into the intussuscipiens
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F1
Ultrasonogram of abdomen showed an intussusception mass measuring 7.1 x 5.0 x 10.1 cm in the right hypochondrium with a few enlarged mesenteric nodes and fat within and adjacent to it [Figure 1a]. Computed tomogram (CT) scan of abdomen with rectal contrast revealed an ileocolic intussusception up to the hepatic flexure with multiple enlarged mesenteric nodes and mesenteric fat pulled into it [Figure 1b].
(a) Surgical specimen of the resected intussusception mass showing the terminal ileum (arrow) intususscepting into the colon (*). The lumen is demonstrated by the clamp. (b) Histopathological examination of the colonic wall showing submucosal caseating granulomata and several Langhans type multinucleate giant cells (Hematoxylin and Eosin, x50). (c) Acid-fast staining of the tissue specimen revealed numerous long, curved and beaded pink staining acid-fast bacilli (Ziehl-Neelson, x1000). (d) Langhans multinucleate giant cells are formed by the fusion of epithelioid macrophages with nuclei arranged in a horse-shoe pattern at the periphery of the cell (Hematoxylin and Eosin, x100)
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F2
The patient underwent an emergency exploratory laparotomy with resection of the ileocolic intussusception, the adjacent ascending colon and terminal ileum [Figure 2a]. Langhans type multinucleated giant cells and central foci of caseation [Figure 2b and d]. Long, curved and beaded AFB, morphologically typical of Mycobacterium tuberculosis (MTB), were detected in all the above-mentioned lesions [Figure 2c].