Author: Tim Milligan

Represents a stenosed featureless colon.
The differential diagnosis for this includes:

1. Long standing (burnt out) ulcerative colitis
2. Granulomatous colitis
3. Unused bowel (bypassed colon with ileostomy)
4. Cathartic bowel (rare – usually right colon, spares rectum)
5. Colonic amyloidosis
6. Scleroderma

Colon appears like a smooth tube due to loss of haustrations; ileocecal valve widely patent with involvment of terminal ileum.

LLD abdominal radiograph showing extreme dilatation of the transverse colon. [Courtesy Dr. N. Jaffer]

Volvulus – Bird-beak sign
Contrast enhanced study illustrating the “bird-beak” sign associated with cecal volvulus. [Courtesy of Dr. N. Jaffer]

This patient had sigmoid volvulus.

Axial CT image of large bowel obstruction secondary to large intraluminal sigmoid mass. [Courtesy of Dr. N. Jaffer]

Dilated loop of colon (>6 cm) with visible haustra. [Courtesy of Dr. N. Jaffer]

Ischemia – Thumb-printing sign
The above images demonstrate the “thumb-printing” sign typical of colonic ischemia. It is most notable in the transverse colon on the left image, and the transverse and descending colon on the right image. [Courtesy of Dr. N. Jaffer]

Mucosal and submucosal herniations through muscular layer of bowel. [Courtesy of Dr. G. Olscamp]

Classic “apple core” malignant lesion in transverse colon. [Courtesy of Dr. G. Olscamp]