P-028 All Is Not Inflammatory Bowel Disease: A Rational Approach to the Finding of Colitis on Abdominal CT Scan

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Abstract

Background:

Computed tomography (CT) is a common tool used in the Emergency Department (ED) for the evaluation of patients with abdominal pain, but findings of colitis are often non-specific and follow-up has not been well defined, leading to incorrect diagnoses or delayed treatments. We describe a patient who presented to our ED with acute gastrointestinal symptoms and abdominal CT findings suggestive of the possibility of Crohn's disease, which was not confirmed in clinical follow-up. We conclude with suggestions for appropriate evaluation of such patients.

Methods:

N/A.

Results:

Case Description:

Results:

A 36 years-old African American man with no significant past medical history presented to the ED with new right lower quadrant abdominal pain, nausea and hematochezia of 2 days duration. There was no known food poisoning and no sick contacts. He denied fevers and had no back or leg pain. He is a never smoker with no family history of IBD. Physical examination revealed a well-nourished man, who was afebrile. Abdominal examination was significant for right lower quadrant tenderness without peritoneal signs. Perianal examination was normal. Laboratory exams including hemoglobin and WBC were normal. Abdominal/pelvic CT revealed a diffuse colitis of the ascending colon, with some involvement of the transverse colon, but no obvious distal colonic abnormality. There was a 1.6 cm enhancing soft tissue lesion in the left psoas muscle. The patient was discharged home without therapy. His symptoms resolved completely within 2 days. Two months later, he continued to be symptoms free and repeat labs including a CRP were normal. Clinical follow-up is planned.

Conclusions:

The finding of colitis on CT often leads to extensive work up including hospital admissions and referrals to a gastroenterologist for further assessment and consideration of a diagnosis of IBD. Although definitive diagnosis relies on endoscopic and pathologic evaluation, certain radiologic findings along with clinical findings may be helpful in differentiating acute from chronic colitis, focusing the differential diagnosis and minimizing unnecessary resource utilization. In our case, lack of systemic inflammation as well as complete resolution of symptoms without therapy supported a likely diagnosis of an acute self-limited infectious colitis rather than a chronic inflammatory disorder. This case also demonstrates the possibility of incidental findings when CT scans are obtained. The psoas finding on the left side is not consistent with Crohn's disease of the ileum and was likely incidental and unrelated. Careful consideration of timing, concomitant laboratory findings, and clinical follow-up are necessary to properly interpret abnormal abdominal CT findings when IBD is suggested.

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