--- a
+++ b/processing/MACCROBAT/25934795.txt
@@ -0,0 +1,34 @@
+A 38-year-old woman presented to our Emergency Department with severe abdominal pain.
+She had no history of drug use or constipation.
+She said that she had intermittent bloody diarrhea.
+Physical examination revealed rebound tenderness and guarding over the abdomen.
+Stool microscopy was negative for amoeba trophozoites or any parasites.
+Fecal occult blood was found.
+Sedimentation was 27 mm/s, CRP (nephelometry) was 65.6 mg/L (normal range 0–5), anti-nuclear antibody was 0.4 (0–0.8 negative), anti-ds DNA <10 (<20 negative), white blood cell count was 14.98 (normal range 4–10), hemoglobin level was 10.9, neutro-phil count was 13.14, platelet count was 473 (100–300), urea level was 17 mg/dl, BUN level was 7.94 mg/dl, creatinine level was 0.56 mg/dl, AST was 20 U/L, and ALT was 24 U/L.
+HIV was negative.
+Abdominal ultrasound scanning showed free fluid at the right paracolic, perihepatic, left paracolic gutters and pelvis.
+Upon detection of air-fluid level and free air under the diaphragm on erect abdominal x-ray, emergency laparotomy was performed.
+In the operation, multiple perforation areas were found in the sigmoid colon, descending colon, and transverse colon.
+Wide resection of the transverse colon with descending and sigmoid colon resection was undertaken (Figure 1).
+Pathergy test was positive.
+The patient had recurrent oral and genital aphthous ulcers 4–5 times within the past year.
+Eye examination results were normal.
+Computed tomography revealed extensive thrombus within the inferior vena cava extending through the right and middle hepatic vein (Figure 2).
+The patient received corticosteroid, anticoagulant, and immunosuppressive therapy.
+Our patient is still alive and healthy 53 weeks later (Figure 3).
+In macroscopy, the transverse colon was 50 cm and sigmoid and descending colon specimens were 27 cm in length.
+Specimens of both colon segments were 4 cm in diameter.
+Perforation areas were evident in the serosal surface.
+Colonic wall and bowel mucosa was edematous and hyperemic.
+Plicae were regular in their course.
+There were 3 roundish, punched-out perforations in the transverse colon and 4 in the descending and sigmoid colon, which were somewhat separate from the colonic wall, with the largest being 2 cm in diameter (Figure 4).
+There were multiple ulcers (the largest was 1 cm in diameter) in different locations, which were not merging together, and were somewhat separate from the surrounding mucosa via a certain limit, covered with exudate and surrounded by a hyperemic region.
+There were no macroscopic lymph nodes in the serosa.
+Numerous samples were taken from ulcerated and perforated regions and normal mucosa.
+The samples were submitted for routine microscopic tissue follow-up.
+Hematoxylin-eosin, tissue Giemsa and PAS-stained slides were prepared for examination.
+In microscopic examination, there were neutrophil leukocyte and lymphocyte reaction around and within the walls and lumens of arterioles, and venules around the perforated and ulcerated lesions (Figures 5 and ​and6).6).
+There were well-organized thrombi and intimal proliferation within some vessels (Figures 7 and ​and8).8).
+There was marked acute peritonitis.
+Surface epithelium and colonic crypts were regular within the colonic mucosa apart from the ulcerated or perforated lesions.
+Samples were free of parasites or their eggs.