Pseudomembraneous colitis with caecal necrosis

Case contributed by Dr Craig Hacking

Presentation

3 weeks of diarrhoea and 3 days of worsening abdo pain and bloating.

Patient Data

Age: 64
Gender: Female

Mural thickening and submucosal oedema of the entire colon, measuring up to 12 mm at the caecum. There is normal enhancement of the colonic mucosa except in the ascending colon where there are small areas of hypoenhancement. Large volume of intermediate density (16HU) free intraperitoneal fluid predominantly in the perihepatic, perisplenic and pelvic spaces. No dilated loops of bowel. No free intraperitoneal gas.

Heterogeneous enhancement of the spleen is due to late arterial phase. The remainder of the intra-abdominal and pelvic organs are unremarkable. IDC in situ.

Old wedge compression fractures of T9, T10 and L1. Sclerotic lesion in T8 is similar to previous study.

Bilateral pleural effusions. Right basal consolidation.

Conclusion

Mural thickening and submucosal oedema of the entire colon in keeping with colitis, likely pseudomembranous given the appearance and further history of antibiotic use. Small areas of hypoenhancing mucosa in the ascending colon raise the possibility of necrosis. Ischaemia may be contributing however the SMA is seen to opacify normally.

Case Discussion

C.difficile positive and there was a history of recent antibiotic use.

The patient was managed conservatively.

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Case information

rID: 40971
Case created: 9th Nov 2015
Last edited: 26th May 2016
Inclusion in quiz mode: Included

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