case_images: PMC6702870_01
case_images: A 60-year-old female with fecal immunochemical test positive and recent onset (3-4 months) of intermittent abdominal pain with loose stools. Colonoscopy image at the splenic flexure showing a dusky and friable appearing colon.
case_images: JCIS-9-18-g001.jpg
case_images: PMC6702870_01_JCIS-9-18-g001.jpg
case_images: F1
case_images: At the splenic flexure, the colon was noted to appear friable with contact bleeding and appeared dusky [Figure 1], progressively worsening while traversing through the transverse colon into the ascending colon and cecum.
case_images: A 60-year-old female with fecal immunochemical test positive and recent onset (3-4 months) of intermittent abdominal pain with loose stools. Coronal reformatted computed tomography images showing colonic wall thickening involving the cecum, ascending colon (a and b), and transverse colon (c) up to the splenic flexure (d), with characteristic threadlike or serpentine calcified subserosal and mesenteric veins (arrows) in the distribution along these bowel loops.
case_images: JCIS-9-18-g002.jpg
case_images: PMC6702870_01_JCIS-9-18-g002.jpg
case_images: F2
case_images: As there were features suspicious of ischemic colitis on colonoscopy, a computed tomography angiography (CTA) of the abdomen [Figure 2a-d] was performed which revealed colonic wall thickening of the ascending colon and transverse colon, along with characteristic threadlike or serpentine calcified subserosal and mesenteric veins in the distribution of the cecum and ascending and transverse colon.
case_images: A 60-year-old female with fecal immunochemical test positive and recent onset (3-4 months) of intermittent abdominal pain with loose stools. Histopathological images of the ascending colon shot at x100 and x200 routine x200 (routine H and E stains) (a and b), and x100 for the Masson's trichrome stain (c) showing diffuse crypt distortion with patchy lymphoplasma eosinophilic infiltrate, crypt atrophy, and moderate degree of crypt loss. The surface epithelium shows mild damage. There are marked lamina propria hyalinization and fibrosis as clearly highlighted in the Masson's trichrome stain (c). All these features are in keeping with chronic ischemic changes that are consistent with phlebosclerotic colitis.
case_images: JCIS-9-18-g003.jpg
case_images: PMC6702870_01_JCIS-9-18-g003.jpg
case_images: F3
case_images: On histopathology [Figure 3a-c], biopsy fragments of the colonic mucosa showed diffuse crypt distortion with patchy lymphoplasma eosinophilic infiltrate, crypt atrophy, and moderate degree of crypt loss.
case_images: A 60-year-old female with fecal immunochemical test positive and recent onset (3-4 months) of intermittent abdominal pain with loose stools. Magnified abdominal radiograph showing faint threadlike linear calcifications (arrows) oriented along the ascending colon.
case_images: JCIS-9-18-g004.jpg
case_images: PMC6702870_01_JCIS-9-18-g004.jpg
case_images: F4
case_images: Careful examination of the abdominal radiograph [Figure 4] revealed linear threadlike calcifications oriented along the ascending colon.