Colon - E. Coli 0157 Colitis
Comments: This 26 year old ICU nurse presented to the hospital with four days of nausea and emesis. Two days prior to admission, she developed profuse diarrhea. On the day prior to admission she passed bloody stools and developed chills and fevers. An abdominal CT scan in the EW demonstrated this thickening of the right colon and possibly the terminal ileum. The differential diagnosis on the basis of the CT was Crohn's ileitis versus acute appendicitis. Colonoscopy performed the day following admission revealed normal mucosa from the rectum to the hepatic flexure. The right colon, however, was inflamed, and edematous. The inflammatory/ ulcerating changes appeared superficial and were associated with abundant mucous formation. Again, the involvement was predominant in the right colon and here in the cecum. The terminal ileum, however, was completely normal essentially eliminating distal small bowel Crohn's disease from the differential. Again, note the edema, superficial inflammation, and abundant mucous. Biopsies were performed and these showed marked injury with prominent lamina propria fibrin deposition and regenerative surface and glandular epithelium. A small vessel shows a fibrin thrombus near the bottom of the biopsy. Six days following admission, her admission stool cultures were positive for ESCHERICHIA COLI (O157).In retrospect, no dietary source was identified. Her recovery was uneventful without antibiotic therapy.
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Abraham L. Brass, MD, PhD G.I. Fellow Massachusetts General Hospital |
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Citation: Brass, AL (Mar 04 2004). Colon - E. Coli 0157 Colitis. The DAVE Project. Retrieved Sep, 4, 2010, from http://daveproject.org/viewfilms.cfm?film_id=98 Times viewed since Feb 2006: 12362 |
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