PMC10186147_01
X-ray and computed tomography images of obstructive colitis.. (a) An X-ray image showing severe colonic dilation from the cecum to the transverse colon. (b-d) Computed tomography images. (b) Obstruction owing to diverticulosis of the sigmoid colon. (c) Enhanced computed tomography image showing maintained blood flow to the colonic wall. (d) Severe dilation of the cecum (>10 cm).
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Radiography and enhanced computed tomography demonstrated colonic dilation with maintained blood flow in the deeper layer of the colonic wall, which was caused by obstruction owing to a stricture with diverticulosis at the sigmoid colon (Figure 1a-c). As the colonic dilation in the cecum was very severe (>10 cm; Figure 1d), we immediately performed endoscopic decompression to avoid perforation.
Endoscopic findings of obstructive colitis before/after endoscopic decompression.. (a) Improved colonic dilation after endoscopic decompression. (b) Mucosa of the dilated colon appears black, suggesting severe ischemia (day 3). (c, d) Colonic mucosa gradually healed following multiple therapy sessions (days 18 and 30).
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The severe dilation of the colon improved successfully (Figure 2a); however, the mucosa of the dilated colon from the right half of the transverse colon to descending colon appeared black, suggesting severe ischemia (Figure 2b). The colonic mucosa healed gradually following multiple therapy sessions for several weeks (Figure 2c,d), and we performed a colostomy without resecting a large part of the colorectum.
The clinical course of the patient.
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Antibiotic treatment and repeated endoscopic decompression (five times; day 3, day 18, day 24, day 26, and day 30) successfully suppressed the colonic dilation and systemic inflammation (Figure 3).