View larger version (120K):
[in this window]
[in a new window]
|
A 74-year-old man presented with a 5-day history of diffuse abdominal pain, constipation, nausea, and vomiting. His abdomen was tympanitic without peritoneal signs. Radiography of the abdomen revealed a dilated small intestine that was consistent with intestinal obstruction. An exploratory laparotomy was performed, and the obstructed segment of intestine was resected. Gross pathological examination revealed a constricted segment of intestine in the region of the ileocecal valve. A sinus tract was present at the distal end of the constriction, adjacent to a 10.5-cm, nonabsorbable suture, with multiple dark-green fecaliths forming a structure resembling a beaded bracelet (inset). Both ends of the suture were attached to the intestinal wall. Microscopically, there was evidence of chronic active inflammation that was consistent with Crohn's disease.
The patient had undergone an exploratory laparotomy for intestinal obstruction due to Crohn's disease 20 years previously. We suspect that the suture from that surgery became a nidus for stone formation.
|
Previous
