Clinical history: A 67 year old female was transferred from a peripheral hospital with increasing abdominal pain. A right hemi-colectomy was performed.
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.