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?

The erect abdominal film:

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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.

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

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