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A 66-year-old Caucasian man underwent bowel cancer screening colonoscopy. He was asymptomatic with no significant medical history and no family history of bowel cancer or IBD. Clinical examination was normal and routine blood tests including haematinics, renal function, electrolytes and liver function were normal. Colonoscopy revealed several shallow periappendiceal caecal ulcers (figure 1). CT revealed caecal thickening with a few small para-caecal lymph nodes. The liver, spleen, small intestine and remaining colon were normal (figure 2).