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Infectious colitis

Case contributed by Dr Derek Smith

Presentation

Admitted with chest sepsis and Clostridioides difficile associated diarrhea. Good clinical response with appropriate antibiotics. New abdominal pain worsening over 24 hours with raised inflammatory markers (WCC 28, CRP 240, lactate 4.5). Generally tender with guarding in left iliac fossa. Dark fluid stool on PR examination. ?colitis ?perforation

Patient Data

Age: 85 years
Gender: Female
X-ray

Loss of bowel wall architecture and thumbprinting consistent with colitic presentation.

No evidence of perforation.

CT

Oral contrast also administered.

Bowel wall edema with enhancement, featureless sigmoid colon and free fluid in keeping with pancolitis. Concertina sign in transverse colon. Fluid filled enhancing small bowel loops.

No pneumoperitoneum. Upper abdominal viscera unremarkable.

Calcified abdominal aorta but major branches patent.

Small bibasal pleural effusions with atelectasis.

Case Discussion

With the history of infection and above imaging findings this lady was managed as an infective pan-colitis, presumed "Clostridioides difficile colitis".

This lady was actively reviewed by the surgical team but was managed conservatively.

This case provides good imaging of colitis which is an important differential diagnosis in abdominal pain and sepsis.

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