Presents with watery diarrhea for 3 weeks, and fevers. Gives a history of infected peritoneal dialysis catheter removed 4 weeks ago, complicated with a formation of abdominal wall abscess, and had a few courses of antibiotics. Examination shows mild tenderness in the abdomen. Laboratory test shows neutrophillia and elevated CRP. CT was performed to investigate for intra-abdominal source of sepsis.
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Contrast enhanced study was performed after discussion with renal physician.
There is gross bowel wall thickening involving the entire colon, with significant pericolonic stranding.
Atrophic kidneys consistent with history of known chronic kidney disease.
History of multiple antibiotic use makes it likely to be pseudomembranous colitis. Empirically treated with oral metronidazole on admission. Fecal study shows the presence of C. difficile toxin, thus confirming the diagnosis. He was slow to respond to treatment and was changed to oral vancomycin, and then he gradually improved.
It is important to observe for development of perforation or toxic megacolon, as this would necessitate operative management.