Case 217

Surgical Pathology Case


  An 18-year-old male presented with small intestinal and colonic lesions with enterocutaneous fistula and pelvic abscess.



The specimen consists of a portion of terminal ileum and ascending colon measuring 29.8 cm in length with a diameter ranging from 1.5 to 5.0 cm. Multiple firm, raised, tan-brown irregular nodules are identified 11.0 cm from the distal surgical margin, the largest measuring 1.6 cm in greatest dimension. The nodules extend for a distance of 8.5 cm proximally. A perforation measuring 1.5 cm in greatest dimension is identified 16.0 cm from the distal surgical margin,. No fistulous tract is identified. Creeping mesenteric fat is identified adjacent to the nodular area. No appendix is identified.


Inflammation involved the entire thickness of the colon. HE, 2

Ulcer on the colonic mucosa. HE, 4


Acute colitis. HE, 20

Granuloma. HE, 20


Acute inflammation on the serosal surface. HE, 20

Inflammation involves ileum. HE, 10


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Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Microscopic photo: Zenggang Pan

Discussion: Zenggang Pan