PMC5366192_01
Computed tomography (CT) scan of the chest reveals diffuse parenchymal nodularity, with no honeycombing, hilar, or mediastinal adenopathy, consistent with stage III sarcoidosis.
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A 67-year-old female with previous medical history of inactive pulmonary sarcoidosis (Figure 1), hypertension, and impaired glucose tolerance, presented to emergency department with five-day history of nausea, vomiting, abdominal pain, and constipation.
Computed tomography (CT) scan of the abdomen demonstrated early complete bowel obstruction at the level of midjejunum.
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A contrasted computed tomography (CT) scan of the abdomen and pelvis demonstrated multiple dilated loops of proximal small bowel with no definitive transition point and no intraperitoneal free air or fluid identified, a picture suggestive of a high-grade small-bowel obstruction (Figure 2).
Gastrografin small-bowel follow-through demonstrated failure of contrast to pass into the colon.
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Her symptoms failed to improve, so gastrografin small-bowel follow-through was performed and demonstrated failure of contrast to pass into the colon (Figure 3).
Intraoperative demonstration of the skin tag appearing lesion at the level of midjejunum causing inflammatory adhesions.
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General surgery was consulted and diagnostic laparoscopy was performed and revealed multiple dilated bowel loops which revealed diffuse skin tag appearing lesions on the antimesenteric surface of the midjejunum causing inflammatory adhesions to the mesentery (Figure 4).
Histopathology of the resected small-bowel lesion. (a) H&E stain revealed lymphohistiocytic noncaseating granuloma with multinucleated giant cells (black arrow). (b) Negative for acid-fast bacilli (AFB) stain. (c) GMS stain negative for fungal infection.
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Histopathologic examination of tissue biopsy revealed lymphohistiocytic noncaseating granulomatous inflammation with multinucleated giant cells, consistent with sarcoidosis (Figure 5).