Sonographische Diagnostik der pseudomembranösen Colitis

BACKGROUND AND OBJECTIVE: The diagnosis of pseudomembranous colitis (PMC) is based on the history of exposure to antibiotics, characteristic endoscopic findings and on demonstrating the presence of Clostridium difficile toxins in the faeces. This report presents typical sonographic features of PMC. PATIENTS AND METHODS: The sonograms of 13 patients with PMC (7 males, 6 females, median age 70 years, range 55-84 years), were retrospectively analyzed. Patients' histories, clinical findings, the results of colonoscopy including histological findings and microbiological tests were related to the sonographic features of inflammation of the colon. RESULTS: At sonography the wall of the colon was thickened (6-17 mm) in each of the patients, different types of changed wall-architecture were seen. In 85% sonographic signs of colitis were restricted to the left colon, whereas in 15% a pancolitis was diagnosed. Ascites was detected in 38%, the colon contents were visible in 85%, in 77% the lumen was narrowed. Colonoscopy confirmed the diagnosis in six patients, in two patients endoscopy was performed only to control the effect of therapy and in five patients endoscopy was thought to be unnecessary. CONCLUSION: Sonography can supplement history and clinical findings if PMC is suspected. Potentially life-saving therapy can be initiated even if colonoscopy has not been performed and results of microbiological assessment are not yet available. However, the diagnosis of PMC remains to be based on the gold standard of colonoscopy and histological findings.