PMC5519404_01
Abdominal/pelvic CT with intravenous and oral contrast demonstrating continuous bowel ischemia, submucosal edema, and inflammatory stranding involving rectum (left) and distal sigmoid colon (right).
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F1
CT revealed thickening of the rectosigmoid (Figure 1). Colonoscopy revealed severe edema, granularity, and friable mucosa extending continuously 25 cm from the rectum to the sigmoid and an otherwise normal colon (Figure 2).
Endoscopy showing edematous and friable mucosa of the rectosigmoid.
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F2
CT revealed thickening of the rectosigmoid (Figure 1). Colonoscopy revealed severe edema, granularity, and friable mucosa extending continuously 25 cm from the rectum to the sigmoid and an otherwise normal colon (Figure 2).
Hematoxylin and eosin stain (20x) of rectal biopsy showing withering crypts and reactive epithelial changes, mucosal congestion, and hemorrhage, consistent with ischemic etiology.
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F3
Biopsies from the colonoscopy revealed ischemia (Figure 3).
Endoscopic appearance of ischemia extending 25 cm into the sigmoid from the anal verge.
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F4
A repeat flexible sigmoidoscopy revealed a dusky and necrotic bowel extending 25 cm from the anal verge to the sigmoid colon (Figure 4).
(A) CT arteriogram and (B) three-dimensional representation of the arterial supply to the rectosigmoid.
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F5
General surgery was consulted and a CT angiogram revealed patent vasculature (Figure 5).