Presentation
Blood per rectum and abdominal pain.
Patient Data
The descending and sigmoid colon show changes consistent with colitis with bowel wall thickening. The appearances of the ascending and proximal transverse colon are unremarkable. There is no small bowel dilatation.
Long segment involvement inflammatory change with extensive bowel wall thickening and narrowing of the lumen involving the descending colon to the level of the distal sigmoid. The rectum is less affected. The transverse colon and ascending colon are relatively spared. The appendix has a normal appearance. Ileo-cecal junction and terminal ileum and have a normal appearance. The small bowel is unremarkable.
Minor mesenteric and pelvic lymphadenopathy. Small amount of free fluid present. No free gas identified. No focal collection identified.
Conclusion:
Findings in keeping with long segment colitis. No evidence of complication such as abscess collection or free gas to suggest perforation.
Differential diagnoses include inflammatory bowel disease (particularly ulcerative colitis) or less likely infective etiologies.
The descending colon is featureless and thickwalled (lead pipe).