Pseudomembranous colitis

Case contributed by Assoc Prof Frank Gaillard

Presentation

Two weeks of right iliac fossa pain.

Patient Data

Age: 25 years
Gender: Female

Abdominal x-rays

X-ray

Erect and supine abdominal radiographs demonstrate thickening of the descending colon wall, best seen on supine projection. No evidence of a bowel obstruction or free intra-abdominal gas. 

CT abdomen / pelvis

CT

Performed with oral, intravenous and rectal contrast. Extensive submucosal edema affecting the entire large bowel, as well as a few centimeters of terminal ileum. The remainder of the small bowel is normal in appearance, as is the appendix.  There is a moderate amount of free fluid in the pelvis, anterior to the uterus. No pneumoperitoneum. 

Mildly enlarged mesenteric lymph nodes are prominent, but presumably reactive. 

The liver, spleen, pancreas, kidneys, gallbladder, adrenals and bladder are unremarkable. The visualized lung bases are clear. The uterus and ovaries have a normal appearance.

Abdominal x-ray: Film repeated the next day

X-ray

Residual contrast (from the CT scan performed the previous day) is seen in the colon and outlines very prominent mucosal thickening / edema (thumb-printing). No evidence of colonic dilatation or free gas. 

Case Discussion

This patient elegantly demonstrates a pancolitis with marked mucosal edema resulting in thumbprinting. The diagnosis of Clostridioides difficile colitis was confirmed by isolation of the toxin on a stool sample. 

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