But what about the large bowel? It is very dilated, particularly the transverse colon which has lost its haustral pattern and also demonstrates nodularity of the mucosa. The appearances are those of a colitis, the dilatation suggesting the patient is developing a toxic megacolon. The “thumbprinted” nodular indentations of the mucosa represent pseudopolyposis - oedematous residual mucosal islands on a background of denuded mucosa. There was no pneumoperitoneum but you should be looking for it. The appearance may be due to a variety of causes but histology confirmed the most common aetiology for this appearance -Ulcerative Colitis.
Moral: This case teaches an important lesson. Always look at the whole film, no matter what the cause for the test. Otherwise the next person to look at the film in the analytical fashion you should have might be a lawyer!