Presentation
RLQ pain, tenderness and fever. Day one post colonoscopy with resection of 25 mm cecal polyp and multiple other smaller polyps. WCC 19. Exclude perforation.
Patient Data
Diffuse, circumferential wall thickening, mucosal hyperenhancement, and surrounding fat stranding of the cecum and proximal ascending colon. No pneumatosis. Sigmoid and descending colon diverticulosis. Multiple borderline dilated loops of small bowel scattered throughout the abdomen without a clear transition point. The appendix has a normal appearance. No intraperitoneal free fluid or free gas.
Bilateral perinephric fat stranding. Minor periportal edema. Otherwise, normal appearance of the liver.
Extensive aortoiliac calcification without significant luminal stenosis of its major branches. Normal opacification of the portal vein and its tributaries. No CT size significant abdominopelvic or inguinal lymphadenopathy.
Trace pericardial effusion. Minor bibasal atelectatic change, otherwise the partially imaged lung bases are both clear. Minor generalized osteopenia but no concerning osseous lesions in the lumbar spine or pelvis.
Impression
Diffuse, circumferential wall thickening, mucosal hyperenhancement and surrounding inflammatory fat stranding of the cecum and proximal ascending colon in keeping with post-polypectomy coagulation syndrome. DDx includes infection.
Case Discussion
The patient recovered well after IV antibiotics, analgesia and bowel rest and was discharged following a 2 day admission. A followup CT 3 weeks later (performed elsewhere and not available for upload) confirmed resolution.
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