Presentation
Prolonged fever, diarrhea and abdominal pain with distention
Patient Data
Multiple dilated small bowel loops in central abdomen. The large bowel loops and rectum are mostly not air-filled. No pneumoperitoneum.
Diffuse bowel wall thickening noted involving from cecum till the mid descending colon, where the thickened bowel wall is edematous. It is associated with minimal pericolic fat streakiness. Preserved mucosal and bowel wall enhancement.
The terminal ileal wall is slightly thickened with generalized small bowel loops dilatation. The maximum diameter of dilated small bowel loops measures 3.5cm. No transition point identified.
No intramural gas, portal venous gas and pneumoperitoneum.
Mild to moderate degree of ascites in all peritoneal spaces.
Heterogeneously enhancement of the right renal parenchyma. A few wedge shaped areas of reduced enhancement at the right renal parenchyma.
Case Discussion
In this case, generalized edematous large bowel wall thickening is due to E. Coli infectious colitis, as there is clinical evidence of E. Coli septicemia. Sites of large bowel wall thickening sometimes can denote the likely causative pathogens. Small bowel loops dilatation without transition point in keeping with small bowel ileus.
Heterogeneous enhancement of right kidney parenchyma may indicated CT features of acute pyelonephritis, where later proved to have E. Coli infection from urine culture.
This case showed that multiple sites of organs infection from disseminated E. Coli, including CNS meningitis (CT brain not shown).