Cook R.A., Stewart B. Colour Atlas of Anatomical Pathology
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ALIMENTARY
SYSTEM
Fig. 4.55
Fig. 4.56
Fig.
4.57
Fig. 4.55
Meckel's
diverticulum.
M/3
weeks.
The
Meckel's diverticulum
and the
adjacent
loop
of
small intestine
had
become
incarcerated
in an
inguinal hernia
and the
necrotic bowel segment
was
resected. Note
the
serosal peritonitis affecting
the
small
intestine
on the
left.
Fig. 4.56
Meckel's
diverticulum
with
a
bleeding
peptic
ulcer.
M/25.
The
ulcer
is
present
at the
junction
between
the
diverticulum
and the
adjoining ileal mucosa
at
the
upper
end of the
specimen.
His
presenting symptoms were typical
of
this
condition: sudden onset
of
abdominal pain,
closely
followed
by the
passage
of
bright
red
blood
per
rectum.
Fig. 4.57
Meckel's
diverticulum.
Acute
inflammation.
M/58.
Symptoms
of
acute
appendicitis.
The
patient
had
already
had an
appendectomy. Laparotomy revealed
an
acute Meckel's diverticulitis.
The
diverticulum
was
removed, together with
a
segment
of
terminal ileum.
The
mucosal surface
of the
diverticulum
is red and
inflamed.
The
serosal
surface
is
covered
by
fibrinous exudate.
81
ALIMENTARY
SYSTEM
Fig. 4.58
Jejunal
diverticula.
M/76.
An
incidental
postmortem finding. Note that
the
diverticula
are on the
mesenteric border
of the
bowel, whereas Meckel's diverticulum
is
on the
antimesenteric border.
Fig. 4.59 Exomphalos.
M/1
day. There
is a
defect
in the
abdominal wall
at the
umbilicus.
The
herniated bowel
is
covered
by
a
thin membrane. Untreated, death occurs from infection
when
the
membrane ruptures.
82
Fig.
4.58
Fig.
4.59
ALIMENTARY
SYSTEM
Fig. 4.60
Fig. 4.60 Volvulus
of the
small
intestine.
M/2
days. Most
of
the
small intestine
is
gangrenous, resulting from twisting
on its
mesentery
at the
duodenojejunal junction.
Fig. 4.61
Multiple
areas
of
atresia
in the
jejunum.
M/2
days. This child presented with intestinal obstruction, which
was
cured
by
resection
of the
atretic segment.
The
atresia consists
of
multiple small blindly ending segments
of
intestine.
Fig. 4.62
Meconium
ileus.
M/6
hours.
The
neonate
presented with intestinal obstruction shortly after delivery.
The
small
intestine
is
dilated
and
filled
with
green,
sticky
material.
This
condition represents
the
presentation
of
mucoviscidosis
in
the
neonatal period.
The
segment
of
atresia
is not
related
to the
mucoviscidosis.
Fig.
4.62
83
Fig. 4.61
ALIMENTARY
SYSTEM
Fig. 4.64
84
Fig. 4.63
ALIMENTARY
SYSTEM
Fig. 4.65
Fig.
4.66
Fig. 4.63
Ischaemic
necrosis
of the
small
intestine.
F/65.
This
was
caused
by
thrombosis
of the
superior
mesenteric artery
(arrow).
Postmortem finding.
Fig. 4.64 Crohn's
disease
of the
terminal
ileum.
M/21.
The
patient
presented
with
recurrent
attacks
of
lower
abdominal
pain
and
vomiting
for 6
weeks.
A
mass
was
palpable
in the
right
iliac
fossa.
The
surgical
specimen
shows
terminal
ileum
with
a
thickened
wall
and
thickening
of its
mucosal
surface—the
so-
called
'cobble
stone'
appearance.
An
adjacent
loop
of
ileum
has
become adherent
to it and an
ileo-ileal fistula
is in the
process
of
developing.
Fig. 4.65 Typhoid. M/23. Postmortem specimen
of
small
intestine.
The
Peyer's
patches
are
prominent.
There
is
ulceration
and
haemorrhage into most
of
them.
The
pathologist's finger
identified
the
site
of a
perforation
in the
middle
of the
largest
area
of
ulceration
and
haemorrhage.
Fig. 4.66
Tuberculosis.
F/28. Postmortem specimen
of
small
intestine. There
are
multiple
oval ulcers running transversely
across
the
bowel.
The
patient died from untreated disseminated
tuberculosis.
85
ALIMENTARY
SYSTEM
Fig. 4.67
Fig.
4.68
Fig. 4.67 Acute
peritonitis
resulting from
a
small perforation
in
the
caecum. Newborn child with
neonatal
necrotizing
enterocolitis.
Note
the
dilated
bowel
with
a
dull
red
serosal
surface,
on
which there
is a
fibrinous exudate.
Fig. 4.68
Radiation
enteritis.
M/83.
The
patient
had a
carcinoma
of the
prostate which
had
been treated
by
radiotherapy.
Some
time
after
this
he
developed
symptoms
of
intestinal obstruction,
and
this loop
of
small intestine which
had
become incarcerated
in the
pelvis
was
resected.
The
mucosa
is
ulcerated
and
lined
by a
greenish-yellow purulent membrane.
Fig. 4.69
Intussusception
causing
acute
intestinal
obstruction.
M/33.
The
apex
of the
intussusceptum consists
of
an
adenocarcinoma.
Fig. 4.70
Acute
obstruction
of the
ileum.
F/80.
Examination
of the
resected bowel showed that
the
obstruction
was
caused
by a
partially dissolved potassium tablet.
The
bowel
on
the
left
is
dilated
proximal
to the
obstruction.
86
ALIMENTARY
SYSTEM
Fig.
4.70
87
Fig.
4.69
ALIMENTARY
SYSTEM
Fig. 4.73
Fig. 4.74
88
Fig. 4.71
Fig. 4.72
ALIMENTARY
SYSTEM
Fig.
4.75
Fig.
4.77
Fig. 4.71
Enterogenous
cyst
of the
ileum.
M/48.
The
small
cyst
in the
ileal wall
had
caused intestinal obstruction.
It
consists
of
a
partial duplication
of the
bowel. Duplications
can
occur
anywhere
along
the
gastrointestinal tract.
They
are
usually short
segment duplications,
and
when they cause symptoms they
are
those
of
obstruction.
Fig. 4.72
Duplication
of the
proximal
portion
of the
ascending
colon.
F/2.
Fig. 4.73
Endometriosis
of the
terminal
ileum.
F/50. This
blood-filled cyst
had
caused intestinal obstruction.
Fig. 4.74
Intestinal
obstruction
with infarction
of a
loop
of
small
bowel caused
by a
fibrous band. M/60.
The
patient
had
had an
appendectomy
25
years
previously.
Fig. 4.75
Gallstone
ileus.
F/77. This woman
had
complained
of
intermittent abdominal pain
for
some months.
She
finally
developed complete obstruction,
the
cause
of
which
was
undiagnosed prior
to
death. There
is an
obstruction
in the
small
intestine with dilatation proximal
to it. The
thickened gallbladder
is
adherent
to the
second part
of the
duodenum
(arrow).
Fig. 4.76
On
opening
the
bowel shown
in
Figure 4.75,
a
single
large
gallstone
was
found
to be the
cause
of the
obstruction.
Fig. 4.77 Same case
as
Figure 4.75.
A
large fistula
was
present
between
the
gallbladder
and the
second part
of the
duodenum.
Repeated
attacks
of
cholecystitis resulted
in
adhesion
of the
gallbladder
to the
duodenum. Necrosis
of the
intervening tissue
allowed
the
gallstone
to
pass into
the
duodenum. Gallstone ileus
and
Richter's hernia
(Figure
4.54)
are
causes
of
difficult-to-
diagnose intermittent abdominal pain
in
elderly patients.
89
Fig.
4.76
ALIMENTARY
SYSTEM
Fig. 4.79
90
Fig. 4.78