Hidebound bowel sign

Dr Henry Knipe and Dr Andrew Dixon et al.

The hidebound bowel sign refers to an appearance on a barium study of the small bowel in patients with scleroderma. The sign describes the narrow separation between the valvulae conniventes which are of normal thickness despite dilatation of the bowel lumen.  

Although the term hidebound is used specifically to describe scleroderma, the same appearance can be present in sprue. Stack of coins is an alternate descriptive term that can be used for both conditions. 

The cause of hidebound appearance in scleroderma is thought to be asymmetric smooth muscle atrophy of the inner circular muscularis layer relative to the outer longitudinal layer. Contraction of the longitudinal layer results in foreshortening of the bowel and close packing of the valvulae conniventes.

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