case_images: PMC11286315_01
case_images: Necrosis of the small bowel. Initially reported as typhlitis but later reported as multiple segments of small bowel ischemia, possible anastomotic breakdown, small bowel obstruction, and enterocolitis. The CT scan shows an ischemic jejunum segment and enterocolitis.
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case_images: Clinical symptoms suggestive of ischemia prompted an immediate abdominal CT scan, revealing an ischemic jejunal segment and enterocolitis (Figure 1).
case_images: The ischemic segment (3 cm long) of the proximal jejunum, associated with mesenteric hematomas at the base of the ischemic segment.
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case_images: Operative findings included a 3 cm ischemic segment of the proximal jejunum associated with mesenteric hematomas (Figure 2).
case_images: (A, B) Small intestine tissue with extensive mucosal injury, denudation, necrosis, and sloughed glandular epithelium. Note the fungal forms within the inflammatory-necrotic debris on surface (arrows). 40x (A) and 400x (B) magnification, respectively. (C, D) Congested and partially thrombosed vessels in the small intestine submucosa; fungal forms (arrows) were present in the vascular spaces intermixed with red blood cells. 100x (C) and 400x (D) magnification, respectively. (E, F) Fungal forms (arrows) are highlighted by periodic acid-Schiff stain ((E) 400x) and Grocott methenamine silver ((F) 400x) special stains, respectively.
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case_images: fig3
case_images: Pathology revealed necrosis and yeast in the vascular bed, and the peripheral blood cultures tested positive for C. guilliermondii (Figure 3).
case_images: During surgical exploration, 13 skip areas of compromised small bowel were found, characterized by combinations of stenosis, hematomas, and ischemia. This figure shows stenosed segments of jejunum and necroses of the small intestine.
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case_images: fig4
case_images: Thirteen areas of bowel compromise, characterized by stenosis, hematomas, and ischemia, were found (Figure 4).
case_images: Abdominal wound dehiscence, fat necrosis, from the enterocutaneous fistula. The wound is infected with bacteria Enterobacter cloacae.
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case_images: The patient developed partial wound dehiscence (Figure 5) (cultures positive for Enterobacter cloacae) and drainage of bilious fluid.
case_images: Persistent areas of wall thickening, consistent with enteritis; some areas appear to be slightly improved from the prior study. Layering hemoperitoneum in the pelvis seen in abdomen/pelvis soft view.
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case_images: fig6
case_images: A computed tomography (CT) scan on December 20, 2021 revealed an enterocutaneous fistula and loculated pockets of fluid within the abdomen and pelvis (Figure 6).