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A 58 year old woman with Crohn’s disease was admitted to our hospital with malaise, rigors, bloody diarrhoea, and a vague perianal pain. Her Crohn’s disease was previously well controlled on mesalazine, with few exacerbations and no admissions to hospital. Routine colonoscopy three months previously had shown no active disease.
At admission, her temperature was 39.9°C, blood pressure 90/60 mm Hg, and pulse rate 110/minute. Physical examination was unremarkable with no evidence of perianal sepsis.
Laboratory blood analysis revealed a normal full blood count, urea, and electrolytes. Liver function tests showed bilirubin 92 μmol/l, alanine aminotransferase 204 IU/l, alkaline phosphatase 2320 IU/l, and gamma glutamyl transferase 14401 IU/l. Amylase was 122 U/l and C reactive protein was 312 mg/l. Blood gas analysis revealed a moderate metabolic acidosis.
Plain abdominal and chest x rays were unremarkable. An abdomino-pelvic ultrasound scan showed no abnormalities, and therefore an urgent computed tomography (CT) scan was performed.
What abnormalities do the CT images (figs 1, 2) show?
See page 796 for answer
This case is submitted by:
Robin Spiller, Editor
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