Clinical Presentation

A 39-year-old presents with severe cramping and watery diarrhea after treatment for acute lymphocytic leukemia.

Single-contrast barium study shows diffuse separation of the jejunal loops (small arrowheads) as well as the ileal loops; featureless, ribbonlike ileum (arrow) with luminal narrowing; and markedly thickened, nodular jejunal folds (large arrowhead). The sigmoid colon is also featureless.

Differential Diagnosis

• Graft-versus-host disease (GVHD): This diagnosis is indicated by the classic history and imaging findings of diffuse, ribbon-like bowel.

• Radiation enteritis: Radiation enteritis is usually more localized as it involves structures within the radiation port, but it may also cause ribbonlike or nodular bowel loops.

• Infection by cytomegalovirus (CMV) or Cryptosporidium: This may have a similar appearance and clinical presentation. CMV infection may occur in an immunocompromised host or be secondary to GVHD.