Description
The specimen is a length of large intestine opened to show an area of haemorrhagic ulceration
towards the lower end and an area of haemorrhage at the upper end with an occasional area of
haemorrhage in the intervening tissue. Microscopy of the ulcerated area gave evidence of a
complex series of essentially ischaemic events. The degree of organisation in the ulcerated area
was thought consistent with ischaemic colitis secondary to trauma some three weeks prior to the
removal of this length of bowel. The other haemorrhagic areas were thought to be consistent with
mechanically-induced ischaemia related to torsion. In addition there were changes suggestive of
disseminated intravascular coagulation.
History
This man, some three weeks before this length of bowel was removed, slid from the top
of a pass in the Southern Alps for some 1500 ft downwards on ice and tumbled a further few
hundred feet down a scree slope, spending the night unconscious in his shorts without his pack and
was rescued 24 hours later by helicopter. At that time he was found to have a central temperature
of 27 . He spent the next 5 weeks in the Intensive Care Unit with acute renal failure, badly
frost-bitten feet, severe peripheral neuropathy and a right lateral popliteal nerve palsy, pancreatitis,
ischaemic colitis and severely lacerated legs. Some three weeks after admission he developed a
torsion of the sigmoid colon which led to the removal of this lesion. Some 8 months later he was
fully recovered apart from having lost part of left big toe and with a persistent peripheral neuropathy
affecting the distal half of each foot.