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A 30-year-old male came into the emergency room with a complaint of a 5-day history of disseminated pain in the abdomen, dyschezia, nausea, and persistent vomiting. Patient admitted of being a chain smoker. He did not know of anyone in his family that had cancer or diabetes. Blood pressure was 100/60 mmHg. Heart rate was >100 bpm. Urine showed few epithelial cells and a WBC count of 0-3/hpf. Stool exam indicates no ova/parasite seen but was bloody. His CBC revealed low levels of RBC and hemoglobin and high levels of WBC. ESR was elevated. His abdomen was tympanitic without peritoneal signs. There was a dilation of the small intestine that was consistent with intestinal obstruction in his radiographic result. This obstructed portion of the intestine was resected by exploratory laparotomy. Gross examination: constricted segment of intestine in the region of the ileocecal valve. A sinus tract was present at the distal end of the constriction, adjacent to a 10.5-cm, nonabsorbable suture, with multiple dark-green fecaliths forming a structure resembling a beaded bracelet (inset). Both ends of the suture were attached to the intestinal wall. Microscopic examination: evidence of chronic active inflammation.