This double contrast barium enema reveals an irregular mucosa and numerous
small filled nodules or polypoids throughout the entire colon representative
of inflammatory pseudopolyps in long standing Ulcerative Colitis.
Also visible are small worm like structures that are small groups of residual
mucosa called filiform polyps.
Ulcerative Colitis is one of the two principal inflammatory bowel diseases (IBD), the other being Crohn’s disease. Inflammatory bowel disease is a term that covers conditions that are characterized by inflammation and ulceration of the gastrointestinal tract. Ulcerative Colitis affects the lining of the colon (the large intestine) which becomes inflamed and develops widespread pus-producing tiny sores or ulcers. It is an intermittent disease characterized by flare ups and remissions. The inflammatory pseudopolyps that can be clearly seen on the barium enema image above are little bumps of scar tissue that have developed from granulating tissue during the healing phase of repeated cycles of ulcerations. The patient was a 45 year old male with long standing ulcerative colitis.
Double contrast barium enema in long standing Ulcerative
Colitis case shows classic ‘Lead Pipe’ sign. The image demonstrates
descending colon and sigmoid colon to be featureless with
lack of haustra and narrowing.
Lead Pipe Sign in Ulcerative Colitis patients
The lead pipe appearance of the colon, as demonstrated in the above image, is one of the classic signs of long standing Ulcerative Colitis disease. A non-diseased, or normal bowel, is characterized by small pouches that run along the colon called haustra which give the intestine it’s segmented, ribbed appearance. The haustra play a role in processing waste and in the motility of the bowel. The ‘lead pipe’ presentation is characterized by a featureless colon with a marked lack of haustra, narrowing and foreshortening . Studies of cell structure in chronic ulcerative colitis patients with this sign, suggest alterations in the elasticity, compliance and tone of the colon.(1) Patients who present with narrowing and stiffening of the colon, after many inflammatory episodes over the years, will probably have altered motility and this results in loose stools or diarrhoea even in the absence of inflammation.
Causes of Ulcerative Colitis
The exact cause of ulcerative colitis is unknown to date although it is thought that multiple factors play a role. There is some evidence to suggest that a defective immune response to the normal bacteria in the digestive tract could be a part of the cause. There may also be a genetic predisposition to developing the disease; there is a familial link in that you are at greater risk of having ulcerative colitis if a family member has it. However, to trigger the disease, the genetic factor is not enough alone and it is thought that a combination of environmental factors play a key role.(2)
1. Coulie B, Camilleri M, Bharucha AE, et al. Colonic motility in chronic ulcerative proctosigmoiditis and the effects of nicotine on colonic motility in patients and healthy subjects. Aliment Pharmacol Ther. 2001; 15: 653–663.
2. Miguel Regueiro, MD, gastroenterologist and co-director of the inflammatory bowel disease . University of Pittsburgh