IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Ulcerative colitis

Case contributed by Frank Gaillard
Diagnosis almost certain

Presentation

Blood per rectum and abdominal pain.

Patient Data

Age: 35 years
Gender: Male
x-ray

The descending and sigmoid colon show changes consistent with colitis with bowel wall thickening. The appearances of the ascending and proximal transverse colon are unremarkable. There is no small bowel dilatation.

ct

Long segment involvement inflammatory change with extensive bowel wall thickening and narrowing of the lumen involving the descending colon to the level of the distal sigmoid. The rectum is less affected. The transverse colon and ascending colon are relatively spared. The appendix has a normal appearance. Ileo-cecal junction and terminal ileum and have a normal appearance. The small bowel is unremarkable.

Minor mesenteric and pelvic lymphadenopathy. Small amount of free fluid present. No free gas identified. No focal collection identified. 

Conclusion:

Findings in keeping with long segment colitis. No evidence of complication such as abscess collection or free gas to suggest perforation.

Differential diagnoses include inflammatory bowel disease (particularly ulcerative colitis) or less likely infective etiologies.

5 years later

x-ray

The descending colon is featureless and thickwalled (lead pipe).

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.