2015, Number 1
Diagnosis by cross-sectional imaging of pseudomembranous colitis
Motta-Ramírez GA, Torres-Montoya JM, Martínez-Utrera MJ, Rebollo-Hurtado V, Guizar-López GU
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Language: Spanish
References: 16
Page: 43-65
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ABSTRACT
Introduction: Pseudomembranous colitis is an infectious, potentially lethal colitis, caused by the release of one or more toxins produced by the unopposed proliferation of the bacterium Clostridium difficile. Pseudomembranous colitis is a predominantly hospital-acquired infection, secondary to complications from antibiotic treatment; it is also associated with abdominal surgery and with debilitating diseases such as lymphoma or AIDS.Objective: Recognize the diagnostic code to identify and differentiate pseudomembranous colitis from other types of colitis by means of tomography, analyzing distribution, signs of accordion, double, and bull’s-eye sign; morphology of colon wall, mucosa, and pericolic fat; adenopathies or ascites; and some other specific extracolonic intra-abdominal findings. We relate the different patterns of these points with the corresponding types of colitis, focusing on pseudomembranous colitis.
Material and methods: We conducted a descriptive, observational, cross-section, retrospective, single-site study which included patients admitted to Hospital Central Militar with various clinical diagnoses, over a 3-year period (January 1, 2012, through December 31, 2014) and in whom the possibility of pseudomembranous colitis was identified based on history of pseudomembranous colitis or tomography findings.
Results: Our universe included 53 patients (45% men and 55% women) in orders for studies which required computed tomography; in none of them was use of antibiotics, type, time, or number specified. In relation to history of use of antibiotics associated with pseudomembranous colitis, 50 patients (94%) were identified. In 4% use of antibiotics was not associated with identification of pseudomembranous colitis by computed tomography. Only 2% were on treatment with unspecified oral antibiotics.
Conclusion: The colitides are part of highly common emergency abdominal pathology. Tomography findings, in their etiological diagnosis, are not pathognomonic; however, knowing them helps establish a correct diagnostic approach. Tomographic images are not pathognomonic but, combined with epidemiology and clinical findings, can support a diagnosis of strong probability, if not certainty. To arrive at a correct diagnosis of pseudomembranous colitis, we need to carefully analyze the points we have discussed in this article: distribution, sign of accordion or halo, colon wall morphology, mucosa, fat, adenopathies, ascites, and characteristic findings.
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