case_images: PMC11110832_01
case_images: (a and b) Abdominal CT scan indicates gas and fluid accumulation inside the colon and small intestine.
case_images: JIR-17-3093-g0001.jpg
case_images: PMC11110832_01_JIR-17-3093-g0001.jpg
case_images: f0001
case_images: Computed Tomography (CT) scan of the whole abdomen indicated dilatation in part of the small intestine and colon (Figure 1a and b), and an Magnetic Resonance Imaging (MRI) of the pelvis revealed no fistula. Colonoscopy demonstrated a circumferential ulcer of the transverse colon with spontaneous bleeding and multiple longitudinal ulcers on the descending colon (Figure 2a-c).
case_images: (a-c) Early onset transverse colonic ulcers with spontaneous bleeding, multiple ulcers inside the descending colon.
case_images: JIR-17-3093-g0002.jpg
case_images: PMC11110832_01_JIR-17-3093-g0002.jpg
case_images: f0002
case_images: Computed Tomography (CT) scan of the whole abdomen indicated dilatation in part of the small intestine and colon (Figure 1a and b), and an Magnetic Resonance Imaging (MRI) of the pelvis revealed no fistula. Colonoscopy demonstrated a circumferential ulcer of the transverse colon with spontaneous bleeding and multiple longitudinal ulcers on the descending colon (Figure 2a-c).
case_images: (a-c) Ulcers were present in the transverse colon, and shallow ulcers was seen in the descending colon.
case_images: JIR-17-3093-g0003.jpg
case_images: PMC11110832_01_JIR-17-3093-g0003.jpg
case_images: f0003
case_images: On repeat colonoscopy 3 months after treatment, multiple small ulcers were still visible in the transverse colon (Figure 3a-c), and biopsy of the ulcers suggested positive Congo red staining (Figure 4a and b).
case_images: (a and b) Chronic inflammation of the transverse colonic mucosa with lymphocytosis (HE staining, x100), amyloid deposits are visible in the mucosal layer of the transverse colon through Congo red staining (arrowed).
case_images: JIR-17-3093-g0004.jpg
case_images: PMC11110832_01_JIR-17-3093-g0004.jpg
case_images: f0004
case_images: On repeat colonoscopy 3 months after treatment, multiple small ulcers were still visible in the transverse colon (Figure 3a-c), and biopsy of the ulcers suggested positive Congo red staining (Figure 4a and b).
case_images: (a and b) Abdominal CT ascending colon, transverse colon, and part of the descending colon showing dilatation and fluid accumulation (most dilated at 5.2 cm).
case_images: JIR-17-3093-g0005.jpg
case_images: PMC11110832_01_JIR-17-3093-g0005.jpg
case_images: f0005
case_images: On July 2022, the patient had recurrent abdominal distension, abdominal CT scan reveals dilatation and effusion of colon (5.2cm at the most dilatation) (Figure 5a and b).
case_images: (a and b) Barium enema angiogram indicates revealing sustained contractions and spasms in the transverse colon and left portion of the colon (including the splenic flexure and descending colon).
case_images: JIR-17-3093-g0006.jpg
case_images: PMC11110832_01_JIR-17-3093-g0006.jpg
case_images: f0006
case_images: Subsequently, a preoperative barium enema angiogram was conducted, revealing sustained contractions and spasms in the transverse colon and left portion of the colon (including the splenic flexure and descending colon) (Figure 6a and b).
case_images: (a and b) The reduced number of intermuscular plexuses are visible in the transverse colon. There were no ganglion cells in some plexuses (HE staining, x100), the absence of interosseous ganglia seen through SOX10 staining (arrowed).
case_images: JIR-17-3093-g0007.jpg
case_images: PMC11110832_01_JIR-17-3093-g0007.jpg
case_images: f0007
case_images: This finding supported a diagnosis of ADHD (Figure 7a and b), while ruling out Crohn's disease due to the absence of non-caseous granulomas.