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Case 97

Pseudomembranous colitis

An elderly man presents with sepsis and abdominal pain, post-appendicectomy

G McKenzie

70 year old man, 10 days post appendicectomy presents with generalised abdominal pain and green diarhoea. He was pyrexic and hypotensive with raised inflammatory markers. The surgeons queried an intraabdominal collection. An ultrasound did not demonstrate any obvious intraabdominal abnormality, a CT scan was therefore performed.

Findings

CT Findings

• No obvious collection.
• Smooth circumferential thickening of large bowel (particularly caecum, ascending colon and sigmoid colon).
• Pericolic stranding.

Diagnosis

Pseudomembranous colitis

Discussion

Although some of the changes seen could be secondary to recent surgery, the diffuse large bowel thickening was thought more typical of a colitis. The entire colon was involved (other images not shown). As the patient had antibiotics post-peratively Pseudomembranous colitis was suggested. The presence of Clostridium difficile toxin was confirmed. Ulcerative colitis may have a similar appearance.

References

There is an excellent online poster (in .pdf format) discussing the CT appearances of various colitides at www.massgeneralimaging.org/REMS_Site/work_examples/ posters.pdf/poster1.pdf.

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