Imaging Case of the Week 61

The following abdominal x-rays are from a 35 year old man who presented with abdominal pain and vomiting. What can be seen in the x-rays?

xray abdomen

click to enlarge

The erect abdominal film:

Erect xray abdomen

click to enlarge

[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The erect abdominal x-ray shows multiple fluid levels; there is also paucity of gas in the large bowel.

The supine x-ray is interesting – there are 2 sentinel small bowel loops. The jejunal loop on the left is distended up to 3.8 cms and shows a characteristic stack of coins appearance. The one on the right is a distended ileal loop (about 4cm) and is featureless.

small bowel obstruction

click to enlarge

CT abdomen showed features of terminal ileitis and obstruction at the ileocaecal junction, which strongly suggests the possibility of Crohn’s disease.