Presentation
Severe diarrhea.
Patient Data
Gas pattern: No supine evidence of free peritoneal air. There is a mucosal thickening demonstrated by the thumbprinting sign in the ascending colon. There is a paucity of bowel gas in the descending colon. However correlating with the CT abdomen, likely favors diffuse colitis with a paucity of bowel gas in this region.
No toxic megacolon.
Thumbprinting from mucosal edema.
Severe edema of descending colon from colitis , see CT for correlation.
Accordion sign.
1. Diffuse circumferential wall thickening of the colon and rectum, which remains consistent with a pancolitis and proctitis. Accordion sign is seen.
2.Third spacing and free fluid in peritoneum.
3. Enteric contrast is noted throughout the stomach, duodenum, jejunum, and ileum. No CT evidence for mechanical bowel obstruction.
4. No free air is identified on today's exam to suggest viscus perforation.
5. There is diffuse small bowel wall thickening, which is, at least in part, secondary to fluid overload. However, developing enteritis cannot be excluded.
Case Discussion
Classic radiologic features of severe colitis, here considered infectious in origin due to Clostridioides difficile.