(A, B) Wireless capsule endoscopy (WCE) images of a 47 year old female with a longstanding history of abdominal pain, previously labelled as irritable bowel syndrome and a history of depression. One year previously she presented to another hospital with a possible small bowel obstruction. A small bowel follow through queried possible terminal ileal disease. A subsequent computed tomography scan of the abdomen was normal. She then had a normal colonoscopy although the terminal ileum could not be intubated. Two months later she underwent repeat small bowel follow through which was normal. Because of recurrent abdominal pain and diarrhoea she underwent WCE. The images show mildly stenosed small bowel with ulcers, consistent with Crohn's disease.

 (A) An enterocutaneous fistula that is robustly visualised on axial T1 fast multiplanar spoiled gradient recalled sequence imaging. (B) There is a hint of a fistula on the small bowel follow through but it is much less clearly identified (arrow). Reprinted with permission from the American Journal of Gastroenterology 2005.39

 (A) Abdominal ultrasound in an adolescent with known ileal Crohn's disease and symptoms suggestive of partial small bowel obstruction. The echogram reveals a small bowel loop with a markedly thickened wall (14 mm, normal arrows, left side) in the right lower quadrant, corresponding to the non‐terminal ileum. The bowel lumen (oval) is distended. A normal small bowel loop is illustrated in the right upper quadrant, with normal wall (3 mm, round arrows) and a normal lumen (star). (B) High pulse abdominal Doppler ultrasound in an adolescent with known ileal Crohn's disease and symptoms suggestive of partial small bowel obstruction. The Doppler study reveals an area with greatly increased intramural mucosal blood flow, with >5 vessels/cm² of the area of thickened bowel wall (star). Vessel density is normal in an adjacent uninvolved ileal area (+). These findings were compatible with an inflammatory nature to the obstructive symptoms, directing the patient to medical therapy, rather than a surgical intervention. These figures were kindly provided by Dr Ernest Seidman, McGill University, Montreal, Canada.

 A perirectal fistula identified at rectal endoscopic ultrasound. The figure was kindly provided by Dr David Schwartz, Vanderbilt University, Nashville, Tennessee, USA.

 (A) Double balloon enteroscope. (B) Plain x ray image of the double balloon enteroscope fully inserted per os, in the small bowel to the ileocaecal valve. (C) Small bowel image as viewed by double balloon enteroscope.