A 49-year-old female with a background of stage IV diffuse large B-cell lymphoma and subsequent graft-versus-host disease from a bone marrow transplant presented to a rural hospital in New South Wales, Australia with 12-h history of painless per rectal bleeding and fever. On examination she had a soft, but distended abdomen. Laboratory investigations revealed thrombocytopenia and hypokalaemia. Computed tomography of the abdomen and pelvis had a bizarre appearance due to pneumatosis cystoides coli extending from the ileocaecal junction to the mid-transverse colon. Given her benign abdominal examination, her management was initially supportive with intravenous antibiotics, intravenous fluid resuscitation and correction of electrolyte abnormalities.
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