CASE

The patient is a 34-year-old white woman with abdominal pain, nausea, vomiting, and blood in stool. On physical examination, mild tenderness is present in the right lower quadrant of the abdomen. There is no abdominal distention or evidence of ascites. Murphy's sign is negative. No bruits are heard. No palpable masses, hepatomegaly, or splenomegaly is noted.

A stool guaic test is positive for blood and the WBC count is mildly elevated, but the results of laboratory studies are otherwise normal. An ESR is not performed. The differential diagnosis in this patient includes Crohn's disease and ulcerative colitis—both types of inflammatory bowel disease (IBD)—as well as irritable bowel syndrome, appendicitis, and pelvic inflammatory disease. CT of the abdomen and pelvis is performed (see Figure 1), as is an upper GI series with small bowel follow-through (see Figure 2). What do these imaging studies reveal?

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