case_images: PMC2718127_01
case_images: A 65-year-old man with adenocarcinoma of the ascending colon and phlegmonous enteritis involving the terminal ileum.. A. Ultrasonogram shows marked, diffuse, segmental wall thickening of up to 10 mm in the terminal ileum. The mucosal folds are blunted (arrows).. B. Contrast-enhanced CT scan reveals colonic obstruction, with a well- enhanced concentric mass lesion visible in the hepatic flexure of the colon (arrows).. C. Contrast-enhanced CT scan at the lower level shows concentric thickening of the terminal ileum (arrowheads) along with diffuse dilatation of the ascending colon and small bowel loops. The thickened wall in the terminal ileum shows heterogeneous contrast enhancement and a small, poorly enhanced lesion (arrow).. D. Microscopic examination shows marked edematous thickening of the submucosa, with dense infiltrations of neutrophils and the formation of small irregular abscesses (arrows). The mucosa is intact, with extension of neutrophilic infiltration of submucosa into the muscular layer and serosa.
case_images: kjr-2-235-g001.jpg
case_images: PMC2718127_01_kjr-2-235-g001.jpg
case_images: F1
case_images: The mucosal folds were blunted and there was low level echogenicity (Fig. 1A). Subsequent CT scanning showed a markedly dilated small bowel and ascending colon, with concentric, hyperattenuating, focal wall thickening in the hepatic flexure of the ascending colon (Fig. 1B). In the thickened wall, focal areas of poor contrast enhancement were also noted (Fig. 1C). Neutrophil infiltration extended into the subjacent muscular layer and even to the serosa (Fig. 1D).