PMC8432386_01
Abdominal computerized tomography (CT) scan with intravenous contrast. Results A and B showed extensive colonic intramural air (pneumatosis intestinalis) prominently involving the ascending colon with significant and potentially life-threatening severe dilation of the entire colon, maximally measuring 6.78 cm in diameter without evidence of free air.
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There was no evidence of free air (Figure 1A, B). The large bowel was tortuous and dilated with extensive air-fluid levels and a small amount of free fluid in the pelvis (Figure 1A, B).
Gross examination of the resected colon. A - Segment of rectum measuring 15 cm in length and approximately 4.5 cm in average diameter with mucosa demonstrating diffuse necrosis; B - Area of dilatation identified at the distal end of the resected rectum measuring up to 7 cm in average diameter (arrowhead).
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Opening both segments longitudinally revealed diffusely necrotic mucosa (Figure 2A), which was seen microscopically as extensive, nearly transmural necrosis (Figure 3A) with moderate to severe acute and chronic inflammation (Figure 3B). There was also an area of dilatation identified at the distal end of the resected rectum measuring up to 7 cm in average diameter (Figure 2B).
Microscopic examination showing areas of extensive necrosis (H&E stain). A - Histopathologic examination of the resected colon demonstrated extensive, nearly transmural necrosis; B - with moderate to severe acute and chronic inflammation. Microscopic images were examined at 100x.
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Opening both segments longitudinally revealed diffusely necrotic mucosa (Figure 2A), which was seen microscopically as extensive, nearly transmural necrosis (Figure 3A) with moderate to severe acute and chronic inflammation (Figure 3B).
Microscopic examination showing areas of intestinal endometriosis (H&E stain). Histopathologic examination demonstrating colonic mucosa with endometrial glandular epithelium (black arrow) and endometrial stroma (red arrow) within the submucosa and muscularis propria. Microscopic images were examined at A - 25x; and B - 100x, respectively.
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This represented an area of extensive endometriosis with associated fibrosis and foci of mucosal necrosis (Figure 4).