‘Lead pipe’ colon sign


  • A 52 years old lady
  • Diagnosed ca cervix and completed chemo and radiotherapy 2 years ago
  • Presented with recurrent abdominal pain and change in bowel habit

Imaging findings:

  • Double contrast barium enema demonstrates a featureless descending and sigmoid colon (yellow arrows).
  • These colon show lacking normal haustral marking and narrowed.
  • There are no focal stenoses or masses. No evidence of fistula formation.
  • The ascending and transverse colon appear normal with preserved normal haustral folds. The terminal ileum is distended and normal in appearance.

Radiological diagnosis: Lead pipe sign of colon


  • It describes the rigid and featureless appearance of the colon in chronic ulcerative colitis.
  • The sign is due to a complete loss of haustral markings and and usually a degree of uniform luminal narrowing due to chronic bowel wall thickening.
  • The diseased segment of the colon appearing smooth-walled and cylindrical.
  • It is classically described on barium enema studies however it is also often seen with CT, MRI and plain radiography.
  • It is not a recognized feature of radiation colitis. However in this patient final diagnosis was not known as patient defaulted subsequent follow up.
Author: radhianahassan