Electronic Clinical Challenges and Images in GI

An Unusual Case of Colonic Hemorrhage

Answer to: Image 2: Colonic Necrosis and Perforation Resulting From the Administration of Sodium Polystyrene Sulfonate

The patient subsequently underwent surgical debridement and external drainage of the pancreatic bed. Segmental colonic resection was planned, but extensive acute inflammation of the colonic mesentery led to the alternative of diverting loop ileostomy. Surprisingly, histopathologic analysis of the necrosectomy specimen showed broad, basophilic crystals with a mosaic pattern resembling fish scales. Thus, rather than infected pancreatic necrosis leading to colonic fistula, these histopathologic