Infectious colitis - E. coli 0157:H7

Case contributed by Charlie Chia-Tsong Hsu
Diagnosis almost certain

Presentation

Two day history of abdominal pain, diarrhea and tenesmus. 24 hour history of hematochezia.

Patient Data

Age: 35 years
Gender: Male

Axial and coronal CT images following intravenous and oral contrast administration show diffuse colonic wall thickening with mucosal enhancement involving the cecum, ascending colon, transverse colon and proximal descending colon. Hyperemia can be appreciated with prominence of the pericolonic mesenteric vessels. Mild pericolic fat stranding is present. 

Case Discussion

A fecal sample obtained for culture was positive for E. coli (0157:H7). 

E. coli colitis has a predilection for involvement of the transverse colon and both ascending/descending colon with right-sided predominance. The location of bowel involvement may indicate the type of infectious colitis responsible. 

Typhoid fever (salmonellosis) preferably involves the cecum, ascending colon and invariably the ileum. Shigellosis predominantly affects the descending colon. Campylobacteriosis affects the small bowel and colon. 

Clinical history will often provide clues to the underlying etiology. Non-infectious causes of colitis to be considered include inflammatory bowel disease in adults, ischemic colitis in the elderly and pseudomembranous colitis.

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