Ascending colitis: probable ischemic
2 weeks of worsening abdominal pain. Mild leukocytosis. No diarrhea, melena, or hematochezia.
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Pronounced, circumferential thickening of the ascending colon with submucosal edema. Faint enhancement of the serosa with faint pericolonic stranding and trace amount of fluid in the paracolic gutter.
No other acute findings. Atherosclerosis of the abdominal aorta. Imaged SMA appears patent. Portal, splenic, superior mesenteric veins patent.
An appropriate differential diagnosis for this case would be ischemic or infectious colitis. An infiltrative mass lesion such as lymphoma would be possible, but felt much less likely given the low attenuation appearance of the colonic wall, findings of pericolonic inflammation/stranding, and two week history of worsening abdominal pain with mild leukocytosis.
Ischemic colitis seems most likely in this case given the pronounced submucosal edema in a vascular (ileocolic) distribution. In elderly patients, ischemic colitis most often occurs due to hypoperfusion setting of underlying cardiovascular comorbidities, and much less likely occlusive thromboembolic disease (notice the patient's prosthetic mitral valve, heavy aortic valvular calcifications, and coronary artery calcifications on the coronal reformats). Ultimately, the patient was managed conservatively and did not undergo further intervention due to her advanced age.