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Enterocolitis

Enterocolitis ultrasound case study

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Reporting Panel

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bowel Pathology

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USG

Enterocolitis ultrasound case study

CASE–1

Clinical History

A 38-year-old patient presented with acute abdominal pain, diarrhea, nausea, vomiting, low-grade fever, and abdominal cramps. The patient was referred for abdominal ultrasound to evaluate suspected bowel inflammation and exclude other causes of acute abdomen.

Ultrasound Findings

Ultrasound examination demonstrates diffuse circumferential wall thickening involving multiple small bowel loops and the ascending/transverse colon with preserved mural stratification. Increased mural vascularity is noted on Color Doppler (hyperemia). Mild adjacent mesenteric fat echogenicity and a few reactive mesenteric lymph nodes are present. Trace free fluid is noted within the pelvis. No bowel obstruction, abscess, perforation, pneumoperitoneum, or appendiceal abnormality is identified.

Ultrasound of the bowel. Diffuse bowel wall thickening involving the small bowel and colon with preserved mural stratification, increased mural vascularity, and mild adjacent mesenteric inflammatory changes. These sonographic findings are suggestive of enterocolitis.

Report Line

Diffuse circumferential wall thickening involving multiple small bowel loops and segments of the colon with preserved mural stratification and increased mural vascularity is noted. Mild adjacent mesenteric inflammatory changes, reactive mesenteric lymph nodes, and trace pelvic free fluid are present. No bowel obstruction, perforation, abscess, or pneumoperitoneum is identified. Sonographic findings are suggestive of enterocolitis.

Impression

Features are suggestive of acute enterocolitis involving the small bowel and colon, with associated mild mesenteric inflammatory changes and reactive mesenteric lymphadenopathy.

Recommendation

Clinical correlation with symptoms and laboratory investigations (CBC, CRP, ESR, stool routine examination, stool culture, and inflammatory markers) is recommended. Appropriate hydration and medical management should be instituted. Contrast-enhanced CT abdomen may be considered if symptoms worsen or if bowel ischemia, inflammatory bowel disease, perforation, abscess, or obstruction is clinically suspected. Gastroenterology consultation is advised in persistent or recurrent cases.

Key Learning Points

• Enterocolitis is characterized by inflammation involving both the small intestine and colon.
• Ultrasound commonly demonstrates diffuse bowel wall thickening (>3 mm) with preserved mural stratification and increased Color Doppler vascularity.
• Reactive mesenteric lymph nodes, increased mesenteric fat echogenicity, and small-volume free fluid are common associated findings.
• Infectious enterocolitis is the most common cause, although inflammatory bowel disease and ischemia should also be considered.
• Ultrasound is useful as an initial imaging modality but cannot reliably determine the underlying etiology.
• CT abdomen is more sensitive for evaluating disease extent and detecting complications such as perforation, abscess, or obstruction.
• Persistent symptoms, gastrointestinal bleeding, severe abdominal pain, or systemic toxicity warrant further evaluation with CT and/or colonoscopy.