Toxic megacolon

Increase in gaseous distension of the distal transverse colon, now measuring up to 80 mm in diameter (2 days ago was 60mm60 mm). The transverse colon and sigmoid colon are both featureless consistent with severe colitis. There is faecal loading in the right side of colon. No evidence of free gas or pneumatosis intestinalis. The appearance is concerning for toxic megacolon.

Faecal material particularly in sigmoid and rectum is fluid-like mild hyperaemia and wall thickening is noted involving proximal sigmoid colon, descending colon to the splenic flexure. Distal transverse colon is featureless and dilated to 72mm72 mm. Mid transverse colon is mildly thick walled with mild hyperaemia. Hepatic flexure, ascending colon, caecum within normal limits. No evidence of large or small bowel obstruction. Small bowel within normal limits.

The liver is enlarged spanning 21.4cm.4 cm but otherwise normal. Numerous small hyperdense calculi are noted in the gallbladder without features of cholecystitis. Spleen at the upper limits of normal, 11.8 cm. Adrenal glands and kidneys are within normal limits. Prominent renal pelvis and mild calyceal dilatation is in keeping with hydronephrosis, the ureters can be traced into the bladder, no focal bladder lesions. Gas within the bladder present is due to recent catheterisation.

No lymphadenopathy.

No suspicious bony lesions. Fusion of the right sacral iliacsacroiliac joint while the left sacroiliac joint demonstrates sclerosis and minor erosions at the inferior aspect.

Right subsegmental lower lobe atelectasis. Small non circumferential-circumferential pericardial effusion, no anterior pericardial effusion.

IMPRESSIONImpression

Colitis with some features suggesting inflammatory bowel disease as a possible cause given sacroiliac joint changes.