Lead (Gas) Pipe Sign

In 1923, the ‘most common organic diseases of the colon [were] neoplasms, diverticulitis, tuberculosis, and chronic ulcerative colitis. The roentgenologic study of the colon in these conditions reveals obstruction of the bariumized medium, abnormal changes in its rate of passage, and transitory or constant deformities in the outline of the colon.’ ¹ The roentgenologic diagnosis of these common diseases was discussed in an article written by Russell Carman and Solomon Fineman ¹ from the Mayo Clinic. Regarding the appearance of chronic ulcera-tive colitis they said, ‘The characteristic roentgen-ray finding is a generalized narrowing of the lumen, which may be extreme in places. The contour of the bowel wall appears smooth and unhaustrated, resembling a gas pipe’’ (Figure 1). The pipe analogy has persisted although the term ‘lead pipe’ seems to be used more commonly today. This sign is not pathognomonic for ulcerative colitis since other chronic inflammatory diseases of the colon also can result in a lead-pipe appearance on barium enema examinations. Figure 1 Lead-pipe sign seen in ‘chronic ulcerative colitis. Note marked contraction of the colon.’ Reprinted from Carman and Fineman<xref ref-type="bibr" rid="ref46_1"> ¹ </xref>. The roentgenologic diagnosis of diseases of the colon. <italic>Radiology,</italic> 1923. I, 129–42 with permission of the RSNA https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig46_1_B.jpg"/>