A barium meal follow-through in a 40-year-old woman with recurrent abdominal pain and subacute intestinal obstruction shows a long, smooth, tapered stricture of the terminal ileum with proximal dilatation, but no mucosal destruction or ulceration. The caecum is contracted and pulled upward. These features are MOST suggestive of:

• A Crohn's disease
• B Hyperplastic intestinal tuberculosis ✓
• C Carcinoid tumour
• D Small bowel lymphoma

Explanation

Hyperplastic intestinal tuberculosis classically involves the ileocaecum, producing a long, smooth, tapered stricture of the terminal ileum, a contracted and pulled-up caecum, and widened ileocaecal angle (Fleischner sign), without mucosal destruction. Crohn's disease shows skip lesions, cobblestoning, and rose-thorn ulcers. Carcinoid tumour produces a desmoplastic reaction with mesenteric fibrosis, kinking, and a spiculated stricture, not a smooth long taper. Lymphoma produces an irregular, nodular stricture or aneurysm dilatation.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.