Infectious colitis - E. coli 0157:H7

Case contributed by Charlie Chia-Tsong Hsu


35 year old male with 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. Fecal sample obtained for culture was positive for E. coli (0157:H7). 

Case Discussion

E. coli (0157:H7) 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 give clues to the type of infectious colitides. 

Typhoid fever (salmonellosis) has a predilection for involving the cecum, ascending colon and invariably in ileum. Shigellosis  predominantly affect the descending colon. Campylobacteriosis affect the small bowel and colon. 

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

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