Lead pipe bowel

Case contributed by Dr Jeremy Jones

Presentation

Diarrhea and per rectum bleeding.

Patient Data

Age: Adult
Gender: Male

Double contrast enema

Barium

A featureless descending and sigmoid colon, lacking normal haustral marking is demonstrated. There are no stenoses or masses. No evidence of fistula formation. 

The ascending and transverse colon appear normal with preserved normal haustral folds. The terminal ileum is distended and normal in appearance.  

Case Discussion

This case demonstrates classical lead pipe appearance associated with chronic ulcerative colitis. The normal haustral pattern is to have the most haustra in the right colon with a decreasing amount as one moves distally. It may be normal to have relatively few haustra in the descending colon and sigmoid, and it is important not to overcall the lead-pipe appearance. However, when features are this clear cut, the diagnosis can be made with confidence. 

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