A 28-year-old man with chronic abdominal pain, weight loss, and intermittent diarrhoea undergoes small bowel barium follow-through. The study shows skip lesions, 'cobblestoning' of the terminal ileum, and transverse and longitudinal ulcers with a 'rose-thorn' appearance. These findings are MOST characteristic of:

• A Intestinal tuberculosis
• B Yersinia enterocolitis
• C Small bowel lymphoma
• D Crohn's disease ✓

Explanation

Crohn's disease classically shows skip lesions, cobblestone mucosa (from intersecting longitudinal and transverse ulcers with residual oedematous mucosa), rose-thorn ulcers, and terminal ileum involvement. Intestinal tuberculosis predominantly involves the ileocaecum, shows conical caecal contraction, and short annular strictures without true cobblestoning or skip lesions. Small bowel lymphoma may show aneurysmal dilatation and fistulae but not cobblestoning. Yersinia causes transient terminal ileitis with nodular thickening that resolves.

Reference: Gore and Levine's Textbook of Gastrointestinal Radiology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.