CRF patient on haemodialysis with septic shock and type II respiratory failure on ventilator. Patient has marked abdominal distension and sent for CT to exclude intestinal obstruction.
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The positive contrast is seen passing through the entire bowel loops. Low attenuation marked bowel wall thickening and edema of the entire colon is seen more evident on the transverse colon with consequent encroachment upon the colonic interior lumen (luminal narrowing) and formation of crypt like appearance. The contrast is insinuated between the pseudo-membranes and swollen haustra creating an accordion sign. Noted marked ascites, pleural effusion and atropic kidneys.
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The CT findings are suggestive of pseudomembranous colitis in which clostridium difficile infection is incriminated.