25934795 Visualization

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