case_images: PMC6394365_01
case_images: Abdominal cavity, after lifting up the greater omentum, with evidence of intestinal perforation. A - Purulent exudate in small intestinal loops (black arrow) with adhesions, and hemoperitoneum (white asterisks); B - Extensive small bowel edema, purulent exudate, and focal hemorrhage of mesenteric fat.
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case_images: There was a perforation of the small intestine (Figure 1).
case_images: Rupture and dissection of the cystic artery. Note the soft tissue hemorrhage around the gallbladder neck (arrow). Bar: 1 cm.
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case_images: Careful dissection and microscopic examination of the gallbladder neck revealed rupture and dissection of the cystic artery (Figure 2, 3 and 4).
case_images: Photomicrograph of the cystic duct (one asterisk), and cystic artery (two asterisks) showing dilatation, rupture (black arrow), and a dissecting track with double lumen formation (white arrow), (Verhoeff's stain, 25x).
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case_images: Careful dissection and microscopic examination of the gallbladder neck revealed rupture and dissection of the cystic artery (Figure 2, 3 and 4).
case_images: Photomicrographs of the cystic artery. A - Disruption of the elastic lamina of the cystic artery at point of rupture with blood extravasation, (Verhoeff's stain, 200x); B - Dissecting track between the arterial adventitia and media with double lumen formation. True lumen demarcated by the inner elastic lamina (one asterisk). False lumen located between the inner and outer elastic laminae (two asterisks) (Verhoeff's stain, 200x).
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case_images: Careful dissection and microscopic examination of the gallbladder neck revealed rupture and dissection of the cystic artery (Figure 2, 3 and 4).
case_images: Pathology of the abdominal aorta and iliac arteries. A - Posteriorly opened abdominal aorta with aneurysm and an endothelialized intraluminal band (solid arrow), and dissection and dilation of the iliac arteries with calcifications and hemorrhage (dashed arrow). Composite H&E images of cross-section at the level of endothelialized intraluminal band (asterisk) showing a false lumen or dissecting track (continuous line), and a true lumen (discontinuous line), on the top right; B - Point of cleavage between the adventitia and media (arrow) adjacent to the endothelialized intraluminal band (asterisk) (Verhoeff's stain, 50x); C - False lumen lined by fibrin and fibrous tissue devoid of elastin fibers, which are conserved in the inferior mesenteric artery (asterisk) (Verhoeff's stain, 100x); D - Vascular wall delimiting the true lumen with preservation of elastic fibers of the medial layer and intimal thickening (Verhoeff's stain, 100x).
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case_images: The infrarenal segment of the abdominal aorta exhibited a 4-cm pseudoaneurysm associated with a 2.3-cm intraluminal endothelialized band (Figure 5). Microscopic examination revealed evidence of prior dissection of the aorta and its distal terminal branches by elastin stains (Figure 5).
case_images: Photomicrograph of the hippocampus. Cornu Ammonis-1 (CA1) showing a focus of neuronal heterotopia in the stratum moleculare (dashed arrow) and red neurons in the hippocampal pyramidal layer (solid arrow) (H&E, 100x).
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case_images: The brain weighed 1530 g (RR; 1100-1700 g) and showed signs of mild hypoxic-ischemic damage as well as a focus of neuronal heterotopia in the hippocampus (Figure 6).