Lead pipe sign (colon)

Last revised by Karen Machang'a on 9 Oct 2023

The lead pipe appearance of colon is the classical barium enema finding in chronic ulcerative colitis, and is also seen with other modalities such as CT, MRI or a plain radiograph. There is a complete loss of the haustral markings in the diseased segment of the colon, appearing smooth-walled and cylindrical. 

This appearance results from an increased mucosal regeneration, which in turns lead to muscularis mucosae hypertrophy. When this enlarged muscular layer contracts, it gives the appearance of lead pipe colon 2.

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