case_images: PMC10861164_01
case_images: CT scan of the abdomen and pelvis with contrast. (A) Abnormal circumferential enhancement edematous changes involving portion of the ascending colon and the cecum with direct involvement of the terminal ileum and the appendix (red arrow). Trace free fluid in the pelvis. Heterogenous enhancement involving the psoas muscle measuring 4.2 cm x 2.8 cm suggestive of abscess (red arrow). 
  (B) Incidental findings of two hypoenhancing liver lesions (red arrows), to be followed up with elective outpatient liver MRI after the acute process is over.
case_images: cureus-0016-00000052221-i01.jpg
case_images: PMC10861164_01_cureus-0016-00000052221-i01.jpg
case_images: FIG1
case_images: A CT scan of the abdomen showed abnormal edematous lesions involving portions of the ascending colon as well as the cecum with direct involvement of the terminal ileum and appendix, and trace-free fluid in the pelvis (Figure 1A). The process extended to heterogenous enhancement involving the psoas muscle on the right, where a lesion measuring 4.2 cm x 2.8 cm is present (Figure 1A). There were also incidental findings of two hypo-enhancing lesions, with the largest lesion being adjacent to the gallbladder measuring 2.7 cm x 1.9 cm, and a smaller lesion located lateral to the right lobe of the liver (Figure 1B).
case_images: Histological photomicrographs of right colectomy biopsy specimens. (A) Cecal wall photomicrograph showing intramural fissure and transmural inflammation. (B) Cecal mucosa close to the ileocecal valve showing aphthous ulceration (red star), crypt destruction (blue star), and crypt abscesses (black stars). (C) Photomicrograph of lamina propria showing a large number of plasma cells with an admixture of neutrophils and eosinophils indicating disease flare. (D) Photomicrograph of hyperemic serosa with a large number of inflammatory cells. (E) Muscularis externa showing dilated blood vessels and small epithelioid granulomas (black stars). (F) Pericolonic adipose tissue showing fat necrosis and lymphoid tissue hyperplasia.
case_images: cureus-0016-00000052221-i02.jpg
case_images: PMC10861164_01_cureus-0016-00000052221-i02.jpg
case_images: FIG2
case_images: However, there was extensive abscess formation, areas of ulceration, and possible evidence of a sinus (Figures 2A, 2B). There were areas of dense and confluent chronic inflammation located in the colonic mucosa and wall that extended to the serosa in various regions (Figures 2A-2F). The infiltrate was composed of lymphocytes and plasma cells, with an admixture of neutrophils (Figures 2C, 2D, 2F). Additional findings included aphthous mucosal ulcerations, intramural fissures, and fistulas (Figures 2A, 2B).