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Figure 9b.   Chronic pancreatitis with diffuse colonic necrosis in a 44-year-old man. (a) Contrast-enhanced CT scan shows evidence of extensive pancreatitis with diffuse phlegmonous changes and a fluid collection in the peripancreatic space as well as involvement of the duodenum (arrows). (b) CT scan obtained at a lower level shows bowel wall thickening along the descending and sigmoid colon (arrows). (c) Photograph of the gross pathologic specimen after total colectomy shows diffuse ischemic changes in nearly the entire colon, which are especially severe at the sigmoid colon (S) and rectum (R). The ischemia resulted from direct encasement of the branches of mesenteric vessels by the pancreatitic process.