• infectious diarrhoea
• infective colitis
• inflammatory bowel disease
• endoscopic procedures
• colorectal surgery

A 64-year-old Caucasian male taxi driver was referred for colonoscopy for a six-week history of non-bloody diarrhoea (eight times a day) associated with weight loss and abdominal pain. There were no infectious contacts or relevant travel history. He had a history of hypertension (on amlodipine). Colonoscopy revealed endoscopic evidence of colitis (figure 1). Given the chronic symptoms and patchy inflammation, Crohn’s colitis was considered and urgent gastroenterology outpatient follow-up arranged. While waiting for this appointment, his symptoms worsened significantly (with diarrhoea 20 times a day) so he presented to the emergency department. On examination he had a low-grade fever, sinus tachycardia and a tender, distended abdomen. He was referred urgently to the surgical team. Initial investigations are shown in table 1. CT scan revealed colonic thickening, mesenteric stranding and hypodense liver lesions (figure 2). He was treated with empirical metronidazole, amoxicillin and gentamicin, pending the availability of histological results.