Clostridioides difficile colitis

Case contributed by Vikas Shah


Recent lower respiratory tract infection. Now has diarrhea and abdominal pain.

Patient Data

Age: 75 years
Gender: Female

Circumferential thickening of the colon wall affecting the entire colon. The hasutra are also thickened most markedly in the transverse colon demonstrating the accordion sign. The lumen contains fluid feces. The small bowel is not involved. There is a small volume of ascites. No free gas and no collections.

Known atrophic right kidney. No other significant abnormality.

Case Discussion

Pancolitis is usually due to infection or inflammatory bowel disease, and less commonly ischemia. Multiple features here allow a radiological diagnosis of Clostridioides difficile colitis to be made: recent treatment of a LRTI, no known history of IBD, and in particular, haustral thickening with ascites. This pattern of findings is seen relatively more frequently in this type of colitis. The haustral thickening sometimes leads to a finding known as the accordion sign.

The C. difficile toxin tests were subsequently found to be positive.

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