When radiology meets gastroenterology: an unusual impact

Clinical presentation

A 37-year-old male with small intestinal Crohn's disease requiring distant previous ileal resection and currently in clinical remission without medical therapy was admitted to the hospital with several weeks of migrating abdominal pains that were progressively localised to the right lower quadrant and now associated with vomiting. His abdomen was distended and tender to palpation without guarding or rebound. Laboratory analysis showed haemoglobin level of 16.7 g/dL, white blood cell count of 11 800/mL, creatine level of 0.9 mg/dL, C reactive protein level of 81 mg/dL, and erythrocyte sedimentation rate of 16 mm/hour. Nasogastric tube placement was undertaken with improvement in patient's symptoms. CT imaging is shown (figure 1).

Question

What is the diagnosis?

Answer

CT scan revealed small bowel obstruction at ileocolonic anastomosis with adjacent rounded radiopaque density (arrow) and absence of pneumobilia (figure 1). Colonoscopy under monitored anaesthesia care showed a...

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