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Answers on p 631.
A women, aged 46 years, presented with intermittent periumbilical pain for three years, each episode lasting for 10 to 15 days and at four to six months intervals for three years; antispasmodics often relieved the pain. She also had intermittent diarrhoea. Recently she had an appendicectomy. The retrocaecal appendix was densely adherent to the caecal wall. There was gross thickening of the terminal ileum and mesentery. The postoperative period was uneventful. The appendix showed features of acute inflammation.
Haemoglobin and blood glucose concentrations were normal. A chest x ray film was normal, antimycobacterial antibody was negative, and C reactive protein was normal. Computed tomography confirmed thickening of the mesentery and the bowel wall. Terminal ileoscopy and biopsy were non-contributory. A small bowel enema (fig 1) was performed.
What does the small bowel enema show?
What is the differential diagnosis?
How can you confirm the diagnosis?