PATHOLOGY:
Gross: Received fresh is a right hemicolectomy which includes an 11.0 cm terminal ileum in continuity with a 34.0 cm cecum-transverse colon, with an attached 10.5 x 0.8 cm vermiform appendix and mesocolic fat, measuring up to 4.0 cm in length. The cecum is severely dilated to 15.5 cm in circumference. The remainder of the bowel is also markedly dilated, ranging from 12.0 cm in circumference at the ascending colon to 7.5 cm in circumference at the distal margin. The cecal serosa is smooth and congested. The remainder of the serosa has scant, membranous adhesions and is focally congested. The terminal ileum has poorly defined areas of villous mucosa over roughly a 5.0 x 2.0 cm area. The ileocecal valve is slightly dusky. The colonic mucosa is unremarkable. The appendiceal serosa is smooth and glistening. The appendiceal lumen averages 0.6 cm in diameter and is filled with soft fecal material. The appendiceal wall is partially calcified. Lymph nodes are recovered. The distal margin has attached unremarkable omentum (14.0 x 3.0 x 0.2 cm).
Diagnoses:
Right hemicolectomy with 11 cm terminal ileum and 10.5 cm appendix:
- prominently dilated cecum and right colon, consistent with cecal volvulus with transmural congestion and no other significant abnormality.
- congested terminal ileum and appendix with no other significant abnormality.
- mesenteric lymph nodes with dilated sinuses and reactive lymphoid hyperplasia.
- segment of congested, but otherwise unremarkable, omentum.
Addendum: CD3 and CD20 immunostains of the mesenteric lymph nodes confirm the diagnosis of reactive lymphoid hyperplasia.