The plain supine abdominal film of an elderly male patient with acute onset of rectal bleeding shows a grossly abnormal gas pattern in the descending colon, with a very prominent widespread pattern of thumbprinting (arrows). This is typical of, but not diagnostic of, ischaemic colitis. The splenic flexure is also involved, but less obviously so. In addition, there is non-specific mild gaseous distension of the small-bowel loops.
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