The humble plain abdominal radiograph of the abdomen is all that is needed here. The ascending colon and transverse colon are dilated by air but also by mottled density suggestive of liquid stool. The mucosa though of this segment of the large bowel is unremarkable and there is no bowel wall pneumatosis or free air. There is an abrupt transition at the splenic flexure to completely decompressed descending colon. This segment of the large bowel has no haustra and can be seen to be markedly thickened throughout its length, standing somewhat proud of the properitoneal fat plane lateral to it, likely due to further pericolonic inflammation. These are typical features of a colitis. The distribution would be atypical for an ischaemic colitis and more favourable for inflammatory bowel disease (Ulcerative Colitis or less likely Crohn’s) but also one should consider infectious colitis such as pseudomembranous colitis.
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