case_images: PMC11750833_01
case_images: Images of abdominal CT. CT scans of the abdomen indicated significant thickening in the lower segment of the ascending colon and the ileocecal region, with intestinal shadows observed within. Enhanced imaging revealed multiple ring signs, and a slightly enhanced nodular shadow measuring approximately 24 mm was identified within the intestinal tract. Additionally, the surrounding fat gaps exhibited vague oozing.
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case_images: fig1
case_images: CT scans of the abdomen revealed significant thickening and a mass-like appearance in the distal ascending colon, suggestive of a tumor or tumor-associated intussusception, warranting further examination (Figure 1).
case_images: Evolution of lesions in the ileocecal and ascending colon across three colonoscopies. (A) The initial colonoscopy identified a mass-like lesion in the ileocecal region, and (B) patchy erosion with shallow ulcer formation was observed near the ileocecal area of the ascending colon. Two weeks later, (C) a follow-up colonoscopy showed that the mass in the ileocecal region had evolved into a depressed ulcer, while (D) the original ulcer in the ascending colon had become a shallow erosion. Four weeks after the initial examination, (E) a subsequent colonoscopy revealed that the entire colon had normalized, with no ulcers, erosions, or other lesions observed in the ileocecal region, and (F) the ascending colon was also clear.
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case_images: fig2
case_images: CT findings suggesting the potential presence of colon tumors, a comprehensive gastrointestinal endoscopy was performed. Colonoscopy revealed a tumor like lesion in the ileocecal region (Figure 2A), approximately 2-3 cm in diameter, with a spherical, convex appearance protruding into the intestinal lumen. Additionally, patchy erosion was observed near the ileocecal area of the ascending colon (Figure 2B), with unclear boundaries and a slightly elevated surface where shallow ulcers had formed. Follow-up colonoscopy showed that the previously visible mass in the ileocecal region (Figure 2C) had transformed into a depressed ulcer, approximately 2.5 cm by 1.8 cm, with a white fur-like surface. The original ulcer in the ascending colon had progressed to a shallow erosion (Figure 2D). One month later, a follow-up colonoscopy showed the entire colon had returned to normal (Figures 2E,F), with no ulcers, erosions, or lesions.
case_images: Pathological changes in the ileocecal and ascending colon lesions. (A) Initial pathological examination of ileocecal area revealed mucosal necrosis, hemorrhage and inflammation. (B) The ascending colon showed similar ischemic lesions with loss of surface and upper crypt epithelium, and lack of significant inflammation. After 2 weeks of treatment both the ileocecal valve (C) and the ascending colon (D) showed similar changes: chronic inflammation, focal erosion, crypt distortion and regenerative changes of crypt epithelium. No evidence of malignancy.
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case_images: fig3
case_images: Pathological examination of biopsy tissues from the ileocecal region (Figure 3A) and ascending colon (Figure 3B) revealed superficial bleeding, mucosal necrosis, fibrinous exudation, cellular infiltration of the lamina propria, and glandular loss and atrophy. Biopsies from these areas (Figures 3C,D) confirmed superficial bleeding, mucosal necrosis, fibrinous exudation, cellular infiltration, and glandular loss, consistent with ischemic enteritis.