A 26-year-old man presented with a short history of neck swelling, hiccups and abdominal distension. He had ongoing watery bowel motions after being diagnosed 3 weeks earlier with acute graft-versus-host disease (GVHD) of the colon following an uneventful colonoscopic biopsy. In his medical history, he had undergone a matched unrelated allogeneic stem cell transplant for acute myeloid leukaemia 4 months previously. Medications included immunosuppression with cyclosporine A and prednisolone.
On examination, he appeared well, with no fevers or haemodynamic compromise. Cardiorespiratory examination was unremarkable, and his abdomen was mildly distended, but soft and non-tender with no guarding or rebound. Bowel sounds were present and normal. Rectal examination revealed an empty rectum with no blood present. Routine blood tests had not significantly changed from results obtained 2 weeks previously. Plain abdominal radiographs were reported as unremarkable with no pathological dilatation of the bowel or free air seen. In view of his medical history, and persisting symptoms, axial CT imaging of the neck, chest, abdomen and pelvis was obtained for further investigation.