USG
Colitis ultrasound case study
CASE–1
Clinical History
A 45-year-old patient presented with lower abdominal pain, diarrhea, fever, rectal urgency, and intermittent passage of blood-tinged stools. The patient was referred for abdominal ultrasound to evaluate suspected colonic inflammation and exclude other causes of acute abdomen.
Ultrasound Findings
Ultrasound examination demonstrates diffuse circumferential wall thickening involving the ascending, transverse, descending, and sigmoid colon with preserved mural stratification. The affected colonic segments demonstrate increased mural vascularity on Color Doppler (hyperemia). Mild surrounding pericolic fat stranding and a few reactive mesenteric lymph nodes are noted. Small-volume free intraperitoneal fluid is present within the pelvis. No focal colonic mass, bowel obstruction, abscess, perforation, or pneumoperitoneum is identified.
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| Ultrasound of the colon. Diffuse circumferential colonic wall thickening with preserved mural stratification, increased mural vascularity, and mild surrounding inflammatory fat changes. These sonographic findings are suggestive of colitis. |
Report Line
Diffuse circumferential wall thickening involving multiple segments of the colon with preserved mural stratification and increased mural vascularity is demonstrated. Mild surrounding pericolic inflammatory fat changes, reactive mesenteric lymph nodes, and a small amount of pelvic free fluid are present. No evidence of bowel obstruction, perforation, abscess, pneumoperitoneum, or focal colonic mass is identified. Sonographic findings are suggestive of diffuse colitis.
Impression
Features are suggestive of diffuse colitis with associated mild pericolic inflammatory changes, reactive mesenteric lymphadenopathy, and minimal free intraperitoneal fluid.
Recommendation
Clinical correlation with laboratory investigations including CBC, CRP, ESR, stool routine examination, stool culture, and inflammatory markers is recommended. Gastroenterology consultation is advised. Colonoscopy with biopsy should be considered where clinically indicated to determine the underlying etiology. Contrast-enhanced CT abdomen may be performed if complications such as perforation, abscess formation, toxic megacolon, or ischemic colitis are suspected.
Key Learning Points
- Colitis is characterized by inflammation of the colon due to infectious, inflammatory, ischemic, or other causes.
- Ultrasound typically demonstrates circumferential colonic wall thickening (>4 mm) with preserved mural stratification and increased Color Doppler vascularity during active inflammation.
- Mild pericolic fat inflammation, reactive mesenteric lymph nodes, and small-volume free fluid may accompany active colitis.
- Ultrasound is useful as an initial imaging modality but cannot reliably distinguish infectious from inflammatory or ischemic colitis.
- Colonoscopy with biopsy remains the gold standard for definitive diagnosis of many forms of colitis.
- Contrast-enhanced CT is indicated when severe disease or complications such as perforation, abscess, or toxic megacolon are suspected.
- Persistent bloody diarrhea, severe abdominal pain, fever, or systemic toxicity requires urgent evaluation and management.
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