EDITOR'S QUIZ: GI SNAPSHOT

An unusual cause of abdominal pain

M J Williams¹, S Chippington², J Lund³, A F Goddard⁴

¹ Department of Gastroenterology, Lincoln County Hospital, Lincoln, UK
² Department of Radiology, Derby City General Hospital, Derby, UK
³ Department of Colorectal Surgery, Derby City General Hospital, Derby, UK
⁴ Department of Gastroenterology, Derby City General Hospital, Derby, UK

Correspondence to:
Correspondence to:
Dr M J Williams
Department of Gastroenterology, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK; mike.williams@doctors.org.uk

Keywords: pneumatosis coli; abdominal pain

The first 150 words of the full text of this article appear below.

A 39 year old man presented with right iliac fossa pain. He had a 10 year history of intermittent abdominal pain, diarrhoea, rectal bleeding, and orogenital ulceration. Previous colonoscopy was normal but biopsies showed an early indeterminate colitis. A barium follow through was suggestive of a terminal ileal stricture and a labelled white cell scan showed increased uptake in the right iliac fossa. A diagnosis of ileal Crohn’s was made and he was started on intravenous steroids.

His symptoms settled and he was discharged on oral prednisolone and mesalazine. He subsequently had a colonoscopy which reached into the terminal ileum and looked normal. A week later, the pain recurred in spite of high dose oral steroids. His abdomen was soft with no signs of peritonism. Inflammatory markers were normal and stool cultures were negative. He had a plain abdominal radiograph (fig 1).

View larger version (144K): [in this window] [in a new window]   Figure 1  Abdominal radiograph.

 

What does the x ray . . . [Full text of this article]

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