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A 40 year old previously healthy man presented as an emergency admission with a 10 day history of profuse watery diarrhoea up to 10 times per day but no blood in the stools. He also complained of mild headache, myalgia, and fever. He had vomiting and crampy abdominal pain two days prior to admission. He had last travelled on holiday to Sri Lanka three months prior to this admission, and at that time his daughter suffered from a self limiting diarrhoeal illness.
On examination he was pyrexial at 39°C, pulse was 120 beats/min, and he was clinically dehydrated. He had a flat soft non-distended abdomen and left iliac fossa tenderness. There were no signs of peritonism. His haemoglobin level was 112 g/l. Platelet count was 1070×109, C reactive protein 289 mg/l (normal <10), and erythrocyte sedimentation rate 50 mm/h. Urea and electrolytes and liver tests were normal.
An urgent unprepared colonoscopy was performed (fig 1). What is the diagnosis?
See page 763 for answer
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Robin Spiller, Editor
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