Gross Description -- Severe Abdominal Pain


The specimen is received in three parts:

PART 1 consisted of a knotted mass of small bowel having a grossly dark red necrotic appearance. Two stapled surgical margins were visible on the specimen. The first margin consisted of a 4.5 cm length of small bowel which was light tan and viable in appearance. The opposite margin consisted of a 27 cm length of dusky red necrotic-appearing bowel.

The two stapled ends were opened, revealing grossly viable mucosa at the first margin and dusky red, grossly necrotic mucosa at the second margin. The specimen was unknotted/reduced revealing the central portion of the specimen to consist of 93 cm of intussuscepted bowel having a dusky red, necrotic appearance with no apparent perforations. The specimen was opened, revealing two mucosal polyps.

The first polyp measures 5.0 x 4.5 x 2 cm with stalk measuring 2 cm in length and 1 cm in diameter; it is located at the edge of the intussuscepted region, 6 cm from margin 1. It had a red, beefy, shaggy verrucous appearance reminiscent of a adenomatous polyp; it had no apparent internal structure. The second polyp measures, 4 x 2.5 x 1 cm and was found on the mucosa 34 cm from margin 2 (within the intussuscepted region). It had a firm, slightly lobulated, solid consistency similar to that of a blood clot.

PART 2 was labeled "ileal polyp" and consisted of a tan-white, firm, verrucous polypoid structure measuring, 3.5 cm in length and 1.2 x 0.9 cm in greatest cross-section. The stalk measures 1.5 cm in length and 0.8 cm in diameter.

PART 3 was labeled "appendix" and consists of a light tan grossly normal appendix with para-appendiceal fat, 3.3 x 2.2 x 0.5 cm (including para-appendiceal fats). The specimen was sectioned revealing a light tan-white wall and lumen with no apparent inflammation.




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