case_images: PMC3414004_01
case_images: Pneumoperitoneum near the hypogastric region (a); with parietal pneumatosis of the caecum and sigmoid, compatible with acute ischemia (b).
case_images: CRIM.ID2012-476719.001.jpg
case_images: PMC3414004_01_CRIM.ID2012-476719.001.jpg
case_images: fig1
case_images: Abdominal CT scan revealed a pneumoperitoneum near the hypogastric region (Figure 1(a)) with parietal pneumatosis of the caecum and sigmoid, compatible with acute ischemia (Figure 1(b)).
case_images: An emergency laparotomy revealed intestinal and colonic necrosis which necessitated a 100 cm resection of the terminal ileum and subtotal colectomy with terminal ileostomy (a). An abundant quantity of nonpurulent but foul-smelling fluid was recovered during the surgery. Thick yellowish membranes covering all intra-abdominal organs were also noticed during surgery (b).
case_images: CRIM.ID2012-476719.002.jpg
case_images: PMC3414004_01_CRIM.ID2012-476719.002.jpg
case_images: fig2
case_images: An emergency laparotomy revealed intestinal and colonic necrosis which necessitated a 100 cm resection of the terminal ileum and subtotal colectomy with terminal ileostomy (Figure 2(a)). An abundant quantity of nonpurulent but foul-smelling fluid was recovered during the surgery but without any frank fecal peritonitis (Figure 2(b)).
case_images: An abdominal CT scan documented a lack of enhancement of the distal portion of the small bowel, including the ileostomy, compatible with ischemia (a). Numerous splenic, hepatic, and renal infarcts were visible (b and c).
case_images: CRIM.ID2012-476719.003.jpg
case_images: PMC3414004_01_CRIM.ID2012-476719.003.jpg
case_images: fig3
case_images: An abdominal CT scan documented a lack of enhancement of the distal portion of the small bowel, including the ileostomy, compatible with ischemia (Figure 3(a)). Numerous splenic, hepatic, and renal infarcts were visible (Figure 3(b)).
case_images: Pathological examination (H&E stain) of the colon showed diffuse active and chronic inflammatory infiltrate with extensive necrosis; broad nonseptate hyphae with irregular branching typical of mucormycosis are present (arrow) within this infiltrate and invade blood vessel walls.
case_images: CRIM.ID2012-476719.004.jpg
case_images: PMC3414004_01_CRIM.ID2012-476719.004.jpg
case_images: fig4
case_images: Pathological material sent during the first surgery (appendix, colon, omentum, and intra-abdominal fibrin) all showed broad nonseptate hyphae with irregular branching typical of mucormycosis invading blood vessels (Figure 4).
case_images: Photomicrograph of sporangiophores and mature azygospores.
case_images: CRIM.ID2012-476719.005.jpg
case_images: PMC3414004_01_CRIM.ID2012-476719.005.jpg
case_images: fig5
case_images: Microscopic examination revealed large and mostly nonseptate hyphae, rhizoids, short unbranched and brown sporangiophores up to 500 mum in length, spherical sporangia, ovoidal sporangiospores 4-7 mum long, occasional chlamydospores, and numerous pale to dark brown azygospores (Figure 5).