Unusual cause of abdominal pain and papule

A 45-year-old man developed multiple papules on the abdomen (with sizes of about 2–15 mm) for 9 months (figure 1), intermittent black stool and abdominal pain for 5 months. Colonoscopy revealed chronic inflammation of the colorectal mucosa (pathological results indicated active inflammation of the mucosa and Epstein-Barr virus positive) (figure 2). CT enterography examinations revealed segmental ileal stenosis in the right lower abdomen. The abdominal pain worsened 3 days before admission. Laboratory examinations during hospitalisation showed that C reactive protein was 31.53 ng/L; fibrinogen was 5.77 g/L and D-dimer was 1308 ng/mL, respectively. On the day of hospitalisation, the patient had sudden aggravation of abdominal pain without flatus and defecation. Physical examination showed abdominal tenderness, rebound pain and muscle tension. Abdominal X-ray indicated intestinal obstruction. Emergency laparotomy was performed. During the operation, a large number of gas, yellow …