PMC7746862_01
Discolored serosa mimicking localized ischemia (A; arrow) giving the appearance of annular circumferential rings. This is associated with a circumferential transverse ulcer (C, arrow). The discoloration is caused by congested vessels within remaining muscularis propria and adventitia situated under the ulcer base. (B) shows deep ulceration in the colon.
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F1
An additional 18 cm of small bowel was resected (Figure 1).
Microscopy of the small intestine showing numerous intraepithelial lymphocytes with perinuclear clearing or halo. The inset shows nuclear atypia of these cells including prominent nucleoli. These cells showed a phenotype compatible with refractory celiac disease type II and also showed monoclonal gene rearrangements.
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F2
Furthermore, the biopsies showed no evidence of Inflammatory Bowel Disease and no features of consistent with ischemia (x, xiv) (Figure 2).