Differential Diagnosis for Circumferential Bowel Wall Thickening and Oedematous Changes
Single Most Likely Diagnosis
- Diverticulitis: This condition is characterized by inflammation of a diverticulum in the wall of the colon, which can lead to circumferential bowel wall thickening and oedematous changes, particularly in the sigmoid colon. The increased echogenicity of adjoining mesenteric fat is consistent with the inflammatory process.
Other Likely Diagnoses
- Colonic Carcinoma: A tumor in the sigmoid colon can cause circumferential thickening of the bowel wall. While the primary presentation might not include oedematous changes, advanced stages could lead to such findings due to obstruction or tumor infiltration.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause bowel wall thickening and oedema, especially in the sigmoid colon. The involvement of the mesenteric fat could be part of the inflammatory process associated with IBD.
- Ischemic Colitis: Reduced blood flow to the colon can lead to bowel wall thickening and oedema. The sigmoid colon is a common site for ischemic colitis due to its relatively poor blood supply compared to other parts of the colon.
Do Not Miss Diagnoses
- Intestinal Ischemia: Although less common, intestinal ischemia due to embolism, thrombosis, or venous thrombosis can present with acute bowel wall thickening and oedema. It is critical to diagnose promptly as it can lead to bowel infarction and perforation if not treated urgently.
- Infectious Colitis: Certain infections (e.g., Clostridioides difficile, Salmonella, Shigella) can cause severe colitis with bowel wall thickening and oedema. Identifying the infectious cause is crucial for appropriate antibiotic treatment.
Rare Diagnoses
- Eosinophilic Colitis: A rare condition characterized by eosinophilic infiltration of the colonic wall, which can cause bowel wall thickening and oedema.
- Lymphoma: Although rare, lymphoma can involve the colon and cause circumferential wall thickening. The involvement of mesenteric fat could be part of the disease process.
- Radiation Colitis: In patients with a history of pelvic radiation, radiation colitis can occur, leading to bowel wall thickening and oedema in the irradiated area.