Clinical presentation

A 59 year old man was referred with a one year history of change in bowel habit and a low folate level. He had been opening his bowels more frequently but there was no associated abdominal pain or weight loss. Previous medical history included uveitis. Medication consisted of folic acid and he smoked 40 cigarettes a day. Physical examination was unremarkable. Initial blood tests revealed a normal full blood count, urea and electrolytes, liver and thyroid function, glucose, and C reactive protein A double contrast barium enema was performed (fig 1).

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Figure 1

 Double contrast barium enema.

Question

In fig 1, what abnormality is demonstrated and what diagnostic procedure was then performed?

See page 1168 for answer

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