Teaching Case

The patient presented with clinical symptoms of malbsorption.

The patient presented with clinical symptoms of malbsorption: abdominal cramping pain, chronic diarrhoea, anaemia, weight loss and vomiting and high values of EMA-ab.

A small bowel follow-through X-ray examination showed dilatation of small bowel loops with fold pattern reversal. An MR examination of the abdomen was performed after oral administration of polyethylene glycol contrast agent.

MR examination showed jejunal fold flattening with an increased number of ileal folds and some jejunal intussusception. In addition, the MR examination showed the following extra-intestinal findings: hyposplenism and a complicated cystic mass of the left kidney.

One of the pathologies underlying a clinical picture of malabsorption is coeliac disease. Coeliac sprue is a relatively common disease in European countries with a prevalence ranging between 1:250 and 1:300; it occurs less frequently in the United States, where the prevalence is around 1:6000. However, precise estimation of prevalence is rather difficult, because a number of cases of coeliac sprue go clinically undetected with either silent or latent disease. Diagnostic imaging is useful for diagnosis, and is especially important in the presence of abdominal pain to exclude complicating lesions such as jejunal ulceration with stricture, intussusception, lymphoma, or carcinoma.

Radiological findings of coeliac disease include flattening of the jejuneal folds with an increased number of ileal folds (ileal jejunalisation), and dilatation of small bowel loops.