Abdominal X-ray - Abnormal bowel gas pattern
Bowel wall inflammation

Key points

  • Abdominal X-rays sometimes demonstrate signs of bowel inflammation such as mucosal thickening 'thumb-printing' or a featureless colon 'lead pipe' colon.

Occasionally, abdominal X-rays show signs of inflammation in patients with inflammatory bowel disease. Abnormalities may relate to either acute or chronic stages of disease.

Mucosal thickening - 'thumbprinting'

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Mucosal thickening - 'thumbprinting'

  • This patient presented with an exacerbation of symptoms of ulcerative colitis.
  • The distance between loops of bowel is increased (arrows) due to thickening of the bowel wall. The haustral folds are very thick (arrowheads), leading to a sign known as 'thumbprinting.'

Lead pipe colon

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Lead pipe colon

  • This patient with ulcerative colitis has a featureless segment of transverse colon with loss of the normal haustral markings.
  • This 'lead pipe' appearance is associated with longstanding ulcerative colitis.
  • The distal bowel is always involved in this disease but, as there is no air in the descending colon, this segment of colon is not evidently abnormal.

Toxic megacolon

Toxic megacolon is a potentially life-threatening condition characterized by dilatation of the large bowel without obstruction, in the context of acute bowel inflammation. This may be due to inflammatory bowel disease, especially ulcerative colitis, or other causes of colitis such as infection.

Toxic megacolon

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Toxic megacolon

  • The colon is very dilated in this patient with acute abdominal pain, sepsis, and a known history of ulcerative colitis. The clinical features and X-ray appearances are consistent with toxic megacolon.
  • There is evidence of bowel wall oedema with 'thumbprinting', and pseudopolyps or 'mucosal islands' (red-patches).