Diabetic ketoacidosis-associated gangrenous ischaemic colitis masquerading as acute pancreatitis and differentiated using computed tomography

Diagnosis of an acute abdomen during an episode of diabetic ketoacidosis (DKA) is crucial for providing appropriate treatments and obtaining favourable outcomes, but may be difficult due to its considerable overlap with multiple intra-abdominal diseases in terms of clinical course and laboratory findings. In this study, we presented a case showing signs of an acute abdomen with sharp rises in serum pancreatic biochemical markers during the treatment of DKA with pyelonephritis. Contrast-enhanced computed tomography (CT) was performed to confirm the onset of acute pancreatitis; however, pneumatosis intestinalis and poor enhancement of the rectal wall were detected, indicating the presence of rectal infarction. Hartmann’s procedure was immediately performed, and histological examination of the resected specimen revealed gangrenous ischaemic colitis. The present case highlights DKA as a risk factor of ischaemic colitis and the role of contrast-enhanced CT in the differential diagnosis of an acute abdomen in hyperglycaemic crisis.