PMC4531587_01
Ultrasonography of the gallbladder reveals no abnormal findings with a well preserved continuity of the gallbladder wall.
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ALT, 11 IU/L; amylase, 210 IU/L; lipase, 316 IU/L. An ultrasonographic examination showed that the gallbladder had no abnormal findings but the small intestine showed diffuse dilatation and wall thickening (Figure 1, 2). A computed tomographic examination of the abdomen and pelvis performed with the intravenous administration of contrast media showed severe thickening of the small intestinal wall and small quantity of ascites without any evidence of bowel perforation or acute appendicitis (Figure 3).
Ultrasonography demonstrates diffuse thickening and dilatation of the small intestine.
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ALT, 11 IU/L; amylase, 210 IU/L; lipase, 316 IU/L. An ultrasonographic examination showed that the gallbladder had no abnormal findings but the small intestine showed diffuse dilatation and wall thickening (Figure 1, 2). A computed tomographic examination of the abdomen and pelvis performed with the intravenous administration of contrast media showed severe thickening of the small intestinal wall and small quantity of ascites without any evidence of bowel perforation or acute appendicitis (Figure 3).
Computed tomographic scan shows normal-looking gallbladder (arrow) and diffusely thickened and dilated small bowel wall (arrow heads).
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ALT, 11 IU/L; amylase, 210 IU/L; lipase, 316 IU/L. An ultrasonographic examination showed that the gallbladder had no abnormal findings but the small intestine showed diffuse dilatation and wall thickening (Figure 1, 2). A computed tomographic examination of the abdomen and pelvis performed with the intravenous administration of contrast media showed severe thickening of the small intestinal wall and small quantity of ascites without any evidence of bowel perforation or acute appendicitis (Figure 3).
Angiography of the superior mesenteric artery shows diffuse spasm and multiple stenoses (arrows).
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Abdominal angiography showed multiple stenoses at the superior and inferior mesenteric artery and extensive spasms at the branches of the superior mesenteric artery (Figure 4).
Gross examination of the gallbladder shows a sharply defined, thumb-print like dark red depression (arrow). The remaining mucosa is grossly normal.
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The excised gallbladder appeared grossly normal except for the focal necrotic area without a frank perforation or stone (Figure 5).
Photomicrograph shows a transmural ischemic necrosis with acute inflammation and vascular congestion in the adventitia and perimuscular connective tissue (H&E stain, x40) (A). There is sharp demarcation between the viable region and the ischemic necrotic lesion (arrow) (H&E stain, x100) (B).
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On a pathologic examination, the gallbladder showed a focal area of inflammation and necrosis confined to the microscopically perforated site at the body (Figure 6).