PMC5358900_01
Axial view of an abdominal enhanced CT. Panel A, right subdiaphragmatic calcified peritoneal plaque. Panel B, progression in the thickening of the peritoneum with contrast enhancement, which englobes the intestinal loops and conditions a discrete small bowel distention with the presence of air-fluid levels, compatible with an initial obstructive process. Panel C, inferior view of the pelvis, with left kidney graft without alteration and atrophic changes of the first right kidney graft. Panel D, postsurgical changes of parietal peritoneum resection with an abdominal wall defect and oral contrast leak compatible with enterocutaneous fistula.
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Tomography (CT)) (Fig. 1A and B) was taken which showed evidence of intra-abdominal collections in the right paracolic gutter. These findings were suggestive of peritonitis, with indirect signs of intestinal obstruction due to adhesions. He required an Ileostomy but due to its high output, compromising the patient's hydroelectric balance and nutrition, it was later closed with subsequent fistulas originating from the enterorraphy (Fig. 1C and D).
Colouring of H&E at 200X. In the histological section, there is mesothelial replacement due to a proliferation of fibroblasts and capillaries, accompanied by a chronic and acute inflammatory response with exudation. Subsequently, an acellular layer with calcium deposits is formed and ends with a layer of fibrin.
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Subsequently, the pathology report revealed chronic peritonitis with histologic findings suggestive of a sclerosing peritonitis (Fig. 2).
Observed surgical image of stoniness and thickened peritoneum.
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Associated with fibrinopurulent membranes and intestinal obstruction at the level of the distal ileum, involving multiple segments (Fig. 3, Fig. 4).