HISTOPATHOLOGY
MACROSCOPIC:
1. Distal ileum – a length of small bowel measuring 55mm with a diameter of 23mm narrowed to about 20mm in two areas with sutures which denote the strictures, attached mesentry up to 20mm across. These strictures are located more than 15mm away from the surgical resection margins. The mucosal folds appear more prominent in the structured area ?diaphragm.
2. Mid ileum – a length of small bowel measuring 95mm with a diameter of 30mm. Attached mesentry up to 20mm across. Two sutures marking strictured area of bowel narrowed to 20mm. Strictures are more than 10mm away from the margins. The mucosal folds appear more prominent in the strictured area ?diaphragm.
MICROSCOPIC:
The sections of small bowel show multiple protrusions of sclerosed eosinophilic connective tissue which are primarily based within the submucosa but merging with the overlying muscularis mucosae. The overlying epithelium on most of the tips of the protruberances is ulcerated, adjacent epithelium shows reactive atypia and crypt shortfall. Within the lamina propria is fibrosis with neutrophils eosinophils, lymphocytes and plasma cells. There are prominent neuromuscular and vascular hamartoma like changes including disorganized muscle bundles admixed with nerves, ganglion cells and blood vessels. There are lymphoid aggregates scattered through out the muscularis propria layers at the site of the protruberances. No cryptitis, crypt abscess, intraepithelial lymphocytosis, fissures or granulomas are identified. There is no dysplasia or malignancy.
DIAGNOSIS: Distal ileum and mid ileum – DIAPHRAGM DISEASE.