Lead pipe sign in ulcerative colitis

Case contributed by Andrew Taylor
Diagnosis almost certain


Worsening abdominal pain. Known inflammatory bowel disease. Exclude toxic megacolon.

Patient Data

Age: 50 years
Gender: Female

Gas-filled rectum, sigmoid, descending and transverse colon with mural thickening and lead pipe appearance represents colitis and is in keeping with history of inflammatory bowel disease. No significantly dilated loops of bowel to indicate toxic megacolon.  No signs of pneumoperitoneum or obstruction. No radiopaque gallbladder calculi. Unremarkable appearance of the sacroiliac joints.

Case Discussion

The lead pipe appearance demonstrated in this case is suggestive of ulcerative colitis. This patient had initially been diagnosed with ulcerative colitis, however, was being investigated for possible Crohn disease due to the development of fistulae and strictures. 

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