Bowel inflammatory presentations on computed tomography in adult patients with severe aplastic anemia during flared inflammatory episodes

Figure 7 Characteristic images of case 1. A-C: Characteristic images of the ileocecal region. A massive cluster of fat stranding that was wrapped by the strikingly thickened omentum (purple arrows) was centered on the homogeneously wall-thickened and gas-filled appendix (orange arrows), leading to the diagnosis of a chronic periappendiceal abscess. The periappendiceal inflammatory changes extended to the scrotum along the inguinal canal (red arrows). In the adjacent sigmoid colon, the wall was thickened and stratified with the water holo sign, and the lumen was gas-filled (blue arrows); D-F: Characteristic images of the ascending colon. The ileocecal valve was thickened and strictured (green arrows), proximal to which the ileal lumen was liquid-filled. Bowel wall thickening with irregular mucosal folds, emptied lumen, mural stratification (fat holo sign) and paracolonic fat stranding that was disproportionately less severe than the severity of the colonic wall thickening was present in the ascending colon (yellow arrows). In the descending colon, the wall was also fibrotically thickened; G-I: Characteristic images of an adhesive bowel segment. A segment of adhesive bowel loop with fibrotic bowel wall thickening, peritoneal thickening and hypervascular mesenteric fat stranding was present in the jejunum (white arrows), together with the segmentally gas-filled, segmentally liquid-filled jejunal lumen, suggesting the inflammatory involvement of the upper gastrointestinal tract; J: Characteristic image of the thickened transverse colon. Bowel wall thickening with emptied lumen, mural stratification (water holo sign) and paracolonic fat stranding that was disproportionately less severe than the severity of the colonic wall thickening was present in the transverse colon, suggesting the involvement of a transmural inflammatory condition; K and L: The thickened and stratified sigmoid colon. Of the sigmoid colon adjacent to the massive inflammatory lesion, the wall was thickened and stratified with the water holo sign, and the lumen was gas-filled.