What is your diagnosis?

Discussion and answer

Ischemic colitis with extensive pneumatosis coli

Sections show submucosal empty spaces surrounded by chronic inflammatory cells including multinucleated giant cells (foreign body type). These features are diagnostic of pneumatosis coli. In the epithelium, there are sharply demarcated areas of ulceration in which the surface epithelium and underlying

lamina propria are mostly replaced by acute inflammatory cells. Other changes associated with acute ischemic colitis including hemorrhagic necrosis, fibrinous thrombi and crypt atrophy are also identified in these areas.