This patient with ulcerative colitis (UC) has an oedematous bowel demonstrated on this AXR as ‘thumb-printing’ (arrowheads). The descending colon also shows some mucosal thickening but the ascending colon is normal. This is the typical radiographic pattern of UC

18.2 Gallstone and abdominal aortic aneurysm

A gallstone is clearly seen in the right upper quadrant. There is also a large abdominal aortic aneurysm (AAA) (arrowheads) seen either side of the lumbar spine. This is visible as it is partly calcified

18.3 Foreign bodies

This psychiatric patient swallowed some glass fragments. An AXR was taken to see how far they had travelled and if there was evidence of a complication such as perforation. The glass can be seen clearly over the pelvis. The colonic gas pattern is normal (arrowheads)

18.4 Pneumobilia

Gas in the biliary tree (pneumobilia) can be seen as branching dark lines in the region of the porta hepatis. This detail of the right upper quadrant shows pneumobilia. Other dark lines, such as the lung markings and artefact seen here, should not be mistaken for biliary gas

Inflammatory bowel disease

Inflammatory bowel disease encompasses a group of chronic inflammatory conditions principally affecting the bowel. The commonest conditions are Crohn’s disease and ulcerative colitis and the AXR is primarily used in the assessment of exacerbations and complications. The large bowel normally contains gas and faeces, which solidifies in the descending colon. In inflammatory bowel disease, however, the large bowel may malfunction, causing an absence of solid faecal matter in the descending colon. If the small bowel is involved it may manifest as small bowel obstruction. Crohn’s disease and ulcerative colitis are idiopathic but have a range of extraintestinal features, some of which are linked with the HLA-B27 phenotype. These patients may also suffer from sacroiliitis.