Gambaran Radiologi Kegawat

Daruratan Dan Infeksi Pada

Kasus Digestive

dr Rochmawati Istutiningrum,Sp Rad

 Gas in
stomach

Gas in a few
loops of
small bowel

Gas in
rectum or
sigmoid

Normal Gas Pattern

 Always
air/fluid level
in stomach

A few
air/fluid
levels in
small bowel

Erect Abdomen
 Kegawat Daruratan
Abdomen
Obstruksi
Perforasi
 Large vs. Small Bowel

l Large Bowel
n Peripheral
n Haustral markings don't
extend from wall to wall
l Small Bowel
n Central
n Valvulae extend across lumen
n Maximum diameter of 2"
 Ileus Obstruktif
Prinsip:
Dilatasi pada proximal obstruksi
Kolaps pada distal obstruksi
Lokasi:
Letak tinggi : Small bowel
Letak rendah: Large bowel
 Small Bowel Obstruction
Letak di sentral
Air fluid level pendek pendek
Gas minimal
 Small Bowel Obstruction
Dilatasi sistema usus halus
Tampak adanya gambaran step ladder
pattern : jumlahnya sedikit krn pasien
sering mutah
Tampak coilled spring : Penebalan valvula
coniventes terutama pada jejunum
Small Bowel Obstruction
Tampak adanya
dilatasi sistema usus
halus di sentral
Gambaran valvula
coniventes (panah )
Adanya
perselubungan yang
dicurigai suatu adhesi
(sebab ileus)
Small Bowel Obstruction
Sentinel loop
( suatu segmen usus
yang terisi oleh
udara)
Small Bowel Obstruction
 Large Bowel Obstruction
Letak di perifer
Air fluid level lebih banyak
Gas di rectum tampak
Haustra menebal
Large Bowel Obstruction
Large Bowel Obstruction
 Ekpertise BNO
YTH TS TELAH KAMI LAKUKAN PEMERIKSAAN BNO AP / LLD
KLINIS: ABDOMINAL PAIN
HASIL:
Pre peritoneal fat line kanan-kiri tampak tegas.
Udara usus tampak (+) prominent, tak tampak gambaran distensi systema usus.
Tak tampak distensi pada usus halus dan sistema colon, air fluid level, coil spring maupun herring
bone
Tak tampak udara bebas intraabdominal ekstraluminer
Tak tampak penebalan dinding usus halus
Renal out line dextra et sinistra tampak samar
Psoas line tampak jelas simetris.
Tak tampak opasitas di proyeksi tractus urinarius
Tak tampak discontinuitas pada tulang yang tervisualisasi
Kesan :
Tak tampak gambaran obstruksi maupun udara bebas ekstra luminer
Tak tampak batu opaque di proyeksi tractus urinarius
Tak tampak kelainan pada tulang yang tervisualisasi
 Ekpertise BNO
YTH TS TELAH KAMI LAKUKAN PEMERIKSAAN BNO AP / LLD
KLINIS: ABDOMINAL PAIN
HASIL:
Pre peritoneal fat line kanan-kiri tampak tegas.
Udara usus tampak (+) prominent, tampak gambaran distensi systema usus.
Tampak gambaran air fluid level pendek pendek disertai dengan gambaran coilled spring dan
herring bone apearance (+)
Renal out line dextra et sinistra tampak samar
Psoas line tampak jelas simetris.
Tak tampak opasitas di proyeksi tractus urinarius
Tak tampak discontinuitas pada tulang yang tervisualisasi
Kesan :
Small bowel obstruction
Tak tampak batu opaque di proyeksi tractus urinarius
Tak tampak kelainan pada tulang yang tervisualisasi
 Ekpertise BNO
YTH TS TELAH KAMI LAKUKAN PEMERIKSAAN BNO AP / LLD
KLINIS: ABDOMINAL PAIN
HASIL:
Pre peritoneal fat line kanan-kiri tampak tegas.
Udara usus tampak (+) prominent di bagian distal, tak tampak gambaran udara usus pada cavum
pelvis ( area colorectal )
Tampak gambaaran air fluid level panjang panjang, coil spring maupun herring bone
Tak tampak penebalan dinding usus halus
Renal out line dextra et sinistra tampak samar
Psoas line tampak jelas simetris.
Tak tampak opasitas di proyeksi tractus urinarius
Tak tampak discontinuitas pada tulang yang tervisualisasi
Kesan :
Large bowel obstruction
Tak tampak batu opaque di proyeksi tractus urinarius
Tak tampak kelainan pada tulang yang tervisualisasi
Ileus Paralitik
 Ileus Paralitik
Post operasi
Inflamasi
Peritonitis
Oklusi vaskuler
Hipokalemi
 Ileus Paralitik
Radiologi:
Adanya akumulasi gas pada usus
Dilatasi sistema large dan small bowel
 Pneumoperitoneum
Riglers sign
Foot ball sign
Air sickle
Double gastric fundi sign
Gas di morrisons pouch ( Doges Cap Sign )
Gas di sub hepatic
Gas di omentum minus (leser sac)
Ileus paralitik
Lig falciforme menebal
Triangular gas shadow
Pneumoperitoneum
Rigler Sign
Adanya bayangan
udara di luar sistema
usus sehingga
dinding usus tampak
sangat prominent
Riglers Sign
Decubitus Abdomen Sign
Cupula Sign
Foot Ball Sign
Perforasi
mengakibatkan
cavum peritoneum
terisi cairan dan gas
bersamaan, udara
terperangkap pada
lengkung usus dan
dapat bergerak
Lesser Sac Gas
Panah putih adalah
cupula sign
Panah hitam adalah
lesser sac gas
Doges Cap Sign
Adalah suatu
gambaran udara
bebas di Morrison
pouch
Falciform Ligaments Sign
VOLVULUS
Small bowel :
Dilatasi lumen bowel spiral

Large bowel :
Sigmoid : marked distention
Caecum : air-fluid level in
the pelvis.

8/10/2017
 Radiological Imaging
Coffee bean
Absensi gas di cavum pelvis
TRAUMA
TRAUMA TUMPUL
Pembesaran / pembengkakan organ padat
Terdapat asites, darah, cairan bilous dan
oedema
TRAUMA TAJAM
Kerusakan parenchym organ padat
Perforasi

8/10/2017
Hepatomegali
Aneurisma
Psoas Abscess
Apendicitis Acuta
Calcifikasi Aorta & pancreas
Calcifikasi post trauma
Calc. lymph & abscess
Vas deferens v. Seminalis
Dermoid cyst
Cyst splenic calcification
hernia
hernia
 INFLAMASI
Colitis ulseratif
- Penyakit inflamasi usus (IBD)

- Etiologi: tidak diketahui, sering dihubungkan

dengan kelainan autoimun

- dewasa muda (15-25 tahun)

- Gejala: diare berdarah, dengan atau tanpa

gejala tambahan

- Lokasi: rektum, dapat menyebar ke proksimal

 BAGIAN-BAGIAN KOLON YANG
TERSERANG KOLITIS:

Rektum & bagian bawah kolon = Proktitis

ulseratif

Bagian kiri kolon = Kolitis distal

Seluruh kolon yang terkena = Pankolitis

 Gambaran Radiologis

AKUT KRONIK
-Spasme dan iritabilitas - Pemendekan kolon
- Granularitas mukosa - Lead pipe colon
- titik-titik pada mukosa - Polip filiform (paska polip
- Collar button ulcer inflamasi)
-Thumbprinting - Backwash ileitis
- Haustra menebal atau - Pelebaran ruang presakral
hilang
-Pseudopolyps
 Akut
Grafik: tampak
"collar button" ulcers dan
hilangnya seluruh haustra kolon
descendens dan sigmoid
Federle MP, Jeffrey RB, Desser TS,
Anne VS, Eraso A et al.
Diagnostic Imaging Abdomen.
1th ed. Amirsys. 2004
collar button ulcers (panah)
Memberi kesan keluar melewati
garis mukosa (kepala panah)
Grainger GR, A David. Grainger & Allisons
Diagnostic Radiologi : A textbook of medical
imaging. 3th ed, USA :
Churchill Livingstone. 1997
KRONIK

a) Pemeriksaan enema barium menunjukkan hilangnya lipatan haustra di seluruh

usus descendens dengan ulserasi kecil. Usus besar memiliki gambaran "lead-pipe".
Distribusi dan gambaran yang mengarah pada kolitis ulseratif.
b) Backwash ileitis karena kolitis ulseratif. gambaran dari kolitis ulseratif kronis
pada kolon sisi kanan, kelainan katup ileosekal, pelebaran ileum distal dengan
mukosa granular
Pemeriksaan barium enema kontras ganda pada laki-laki usia 44 th
dengan diagnosa kolitis ulseratif. Terlihat gambaran total kolitis dan
pseudopoliposis luas.( gambar diambil dari :
http://emedicine.medscape.com/article/375166-imaging)
 INFLAMASI
Penyakit Crohn
(kolitis granulomatosa)

Kronik, menyebabkan sikatrik

Lokasi tersering: ileosekal

Gejala: diare, berat badan turun, anemia,

demam

Dapat mengenai bagian manapun dari saluran

pencernaan dari mulut anus
 AKUT KRONIK
Hiperplasia lymphoid Fisura
nodular Fistula
Ulserasi apthosa Hilangnya haustra
Ulserasi dalam Sakulasi
Gambaran cobblestone Pseudopolip post inflamasi
Pseudopolip inflamasi
Distribusi segmental
Skip lesions
 AKUT

Gambar: a.b) aphthoid ulcers multipel

http://www.learningradiology.com/notes/ginotes/crohnsdiseasepag
e.htm )
a. Ulserasi Aphthosa pada ileum terminal (panah kecil) - juga
"cobblestoning" (panah besar).
www.medcyclopaedia.com/library/radiology/chapter22 )
 KRONIK

a) pseudodivertikel pada penyakit Crohn.1

b) Ada perubahan yang terputus-putus yang mengenai kolon transversum
(cobblestoning dan ulserasi) dan sigmoid ringan (ulserasi apthosa dengan
latar belakang mukosa normal). Perhatikan juga striktur terminal ileum
http://www.medcyclopaedia.com/library/radiology/chapter22)
Gambaran khas penyakit Crohn dari ileum distal termasuk ulkus dan fisura
(panah kecil), ulkus longitudinal (panah), "cobblestoning" (panah terbuka),
ulkus aphthosa (panah melengkung) dan striktur. ic = katup ileosekal
www.medcyclopaedia.com/library/radiology/chapter22 )
 Kolitis Ulseratif VS Crohns Disease
UC CD Gamb.radiologi
Spesifik: Spesifik :
Collar button ulcers Nodularity, granularity Mukosa
Granular mucosa Terminal ileum
Diffuse rectal cobble stoning
disease
Continous dis Noncontinous dis /skip lesion: Distribusi
(begins distally):
Kolon
Kolon dan Usus halus Lokasi
>> 90 % Rektale spare Rektal involvement
Perforasi Fistula Komplikasi
Nonspesifik:
<< >> Strikture
>> << Pseudopolyps
>>
<< Total colitis
 a) Distribusi anatomik pada penyakit Chron dan kolitis ulseratif
(gambar diambil dari
http://emedicine.medscape.com/article/375166-imaging)
b) Perbandingan gambaran kolon, histologi dan endoskopik pada kolon
normal, penyakit chron dan kolitis ulseratif.
http://emedicine.medscape.com/article/375166-imaging)
 KOLITIS INFEKSI

Kolitis yang disebabkan infeksi bakteri, virus,

parasit dan jamur

Epidemiologi : kolitis bakterial negara barat

kolitis parasit negara
berkembang

Diagnosis : cukup pemeriksaan rutin kultur

feses
 Bakterial Viral Parasit Jamur

a. Salmonellosis a. Cytomegalovirus a. Amebiasis a.Histoplasmosis

b. Shigellosis (CMV) b. Schistosomiasis b.Mucormycosis
c. Campylobacteriosis c. Strongiloidiasis
d. Yersenia d. Trichuriasis
Enterokolitis
e. E. Colli
f. Tuberkulosis
g. Actinomycosis
 Salmonellosis (Demam tipus)

Gram negatif

Infeksi dengan tertelan

Lokasi tersering: seluruh kolon

Gejala: pireksia
artralgia
malaise
sakit kepala
nyeri abdomen kuadran kanan bawah
Gambaran radiologi:
Hilangnya haustra pankolitis
Collar button ulcer
Thumbprinting
Ulserasi superfisial
Granularitas mukosa
Ulserasi apthosa (masih mungkin)
Tampak gambaran ileum distal yang lurus dan kaku dengan penebalan
dan edema dari lipatan mukosa dan ketidakteraturan lumen. Banyak
ulserasi yang terlihat dari kedua sisi ileum yang menghasilkan kontur
kasar dan berduri. Ada beberapa gambaran radiolusen pada ileum dan
sepanjang konturnya yang mungkin merupakan plak Peyeri yang
membesar. Sekum dan kolon ascendens tidak terisi penuh (diambil dari
http://www.isradiology.org/tropical_deseases/tmcr/chapter15/radiological3
.htm ).
a) Perhatikan bahwa dalam dua film tersebut tampak wilayah ileosekal, pada pemeriksaan
enema barium awal ada kontur yang irreguler pada ileum distal dengan edema berupa
gambaran berduri dari lipatan mukosa serta tampak beberapa ulcerasi bergerigi. b) Dua film
berikutnya diperoleh pada enema barium 18 hari kemudian, setelah ditandai dengan perbaikan
klinis sementara ketika di terapi kloramfenikol. Ileum terminal terlihat membaik dan mendekati
normal, walaupun masih ada sisa minimal edema pada lipatan mukosa. Ada sedikit penebalan
dan kekakuan ileum dibandingkan dengan studi sebelumnya dan tidak ada ulserasi yang tampak
(diambil dari http://www.isradiology.org/tropical_deseases/tmcr/chapter15/radiological3.htm
 Shigellosis

Gram negatif

Dapat sembuh sendiri 7-10 hari

Lokasi tersering: kolon descendens

Gambaran radiologi:
Ulserasi yang dalam
Collar button
Ulserasi apthosa (mungkin)
a) Menyerupai kolitis ulseratif. Pemeriksaan enema barium kontras tunggal
pada pasien dengan kolitis Shigella. Gambar Paska evakuasi yang diperoleh
setelah pemeriksaan enema barium kontras tunggal. Menunjukkan ulserasi
mukosa luas akibat kolitis Shigella.
b) Kolitis shigella. Ulserasi pada kolon sigmoid yang terlihat pada pemeriksaan
enema barium kontras ganda. ( diambil dari:
http://picasaweb.google.com/RadiologyAlbum/GIBoardReview#542438740589
1951506 )
 Campylobacteriosis

Kolitis bakterial tersering

Sembuh sendiri < 7 hari, gejala sampai 1 bulan

Kambuh 25 % jika tidak diobati

Gejala: sakit kepala, mual, muntah, artralgia,

diare cair dan berdarah
Lokasi tersering: kolon descendens

Gambaran radiologi:
Pankolitis Granularitas difus, haustra hilang (mirip
kolitis ulseratif)
Ulserasi apthosa (mirip Crohn)
Pemeriksaan enema barium kontras ganda menunjukkan mukosa
granular yang berhubungan dengan kolitis Campylobacter ( diambil
dari http:// emedicine.medscape.com/article/375166-media )
 Yersinia enterokolitis

Gram negatif

Pasien < 5 tahun nyeri akut abdomen kanan

bawah, demam (mirip appendisitis)

Dewasa demam, nyeri abdomen, diare (4-6

minggu)

Lokasi: ileum terminal

Gambaran radiologi:
- Pembesaran folikel limfoid nodul
- Ulserasi apthosa atau besar yang sering pada kolon
ascendens
- Lipatan kolon menebal
a) Gambaran caecum spiculated dengan terlihat jelas menjauhnya loop
usus yang berdekatan, yang merupakan refleksi dari edema dinding
usus
b) Gambaran nodular ( diambil dari
http://bjr.birjournals.org/cgi/reprint/49/578/181.pdf )
 E.colli

- Sering pada orang dalam perjalanan

- Bisa sembuh sendiri

- Gejala: diare tanpa panas

- Lokasi: kolon transversum yang dapat meluas ke

ascendens dan descendens atau keduanya

- Gambaran radiologi:
- Thumbprinting
- Penyempitan dan spasme usus yang kena
a. anak laki-laki usia 11 tahun dengan diare feses berdarah. Pemeriksaan
enema barium memperlihatkan gambaran thumbprinting yang mengarah
ke edema submukosal yang melibatkan sekum (panah padat) dan kolon
transversum (panah terbuka). (diambil dari :
http://imaging.consult.com/topic/bacterial-Infections)
 Tuberkulosis

Pasien dengan AIDS resiko terbesar

Gejala: berat badan turun

demam
nyeri
diare

Lokasi: ileosekal
Kolon ascendens sampai proksimal kolon
transversum
Gambaran radiologi:
Ulserasi
Penyempitan
Granulasi mukosa dengan nodularitas
Inflamasi polip
Stierlins sign ileosekal tak jelas
Fleischners sign ileosekal jelas
hipertrofi katup ileosekal
a) Ileosekal tuberkulosis. Gambar dari pemeriksaan enema barium kontras ganda
menunjukkan retraksi dari daerah ileosekal, bersama dengan katup ileosekal yang
tidak kompeten. b) Ileosekal tuberkulosis kronis. Para sekum dan kolon ascendens
yang tertarik ke arah kranial dan tampak fibrotik. scar (panah melengkung). Ileum
terminal pada pasien ini relatif patologis (panah lurus) dan mungkin tampak
nodular.
v = katup ileosekal ( Diambil dari http://www.medcyclopaedia.com/library/radiology
)
CLASSIC SIGNS IN GASTROINTESTINAL
RADIOLOGY
 Comb sign

The comb sign is seen in Crohns disease.

Observed on CT or MRI scans.
The teeth of the comb represent engorged
small arteries, the vasa recta, perfusing the
small bowel
The vasa recta of the small bowel become
tortuous and enlarged
 They appear as prominent opacities on the
mesenteric side of the small bowel.
Small arteries become engorged due to
increased blood flow to the inflamed small bowel
and are accentuated due to the fibrofatty
proliferation in the mesentery.
The comb sign suggests an acute exacerbation
of Crohns disease.
 FIGURE 14. (A) Comb. (B) Contrast-enhanced CT image in a
patient with Crohns disease demonstrating engorged vasa
recta secondary to hyperemia of the bowel producing the comb
sign.
 Target sign
The target sign an enhancement pattern of the
bowel wall seen in various disease processes on CT
or MRI scans.
The target-like is formed when a thickened bowel wall,
with an inner and outer layer of higher attenuation and
a middle layer of lower attenuation
 Target sign
The inner and outer layers represent the mucosa and
muscularis propria, respectivelythese layers is
believed contrast enhancement from inflammation.

The middle layer is submucosal bowel wall edema

can be seen even on noncontrast-enhanced CT if
severe
 Target sign
Classically seen in patients with Crohns disease.

It can be seen in many other conditions(patients with

radiation enteritis, ischemic bowel, intramural
hemorrhage, vasculitides suc, and
pseudomembranous colitis)
FIGURE 15. Target. (A) Emergency stop button (B) Contrast-enhanced CT image of
the small bowel in a patient with Crohns disease reveals rings of high attenuation
representing the hyperemic mucosa and muscularis propria of the small bowel.
The hypodense ring represents the edematous submucosa. This enhancement
pattern creates the target sign.
 Coiled spring sign

The coiled spring appearance only occurs in the

dilated air-filled small bowel.
It also is most noticeable in the jejunum where
the valvulae conniventes are closely spaced
Coiled spring sign
 Arrowhead sign

The arrowhead sign observed on CT images

in acute appendicitis.
This perceived trapped in the thickened,
inflamed cecum.
Represents a secondary sign of appendicitis
have a sensitivity of roughly 30%.
FIGURE 17. (A) Arrowhead.. (B) Contrast-enhanced CT image in a patient
with right lower-quadrant pain demonstrates arrowhead-shaped
inflammatory changes of the cecal base secondary to acute appendicitis.
Note the thickened appendix
 Thumbprint sign

Was first described in 1963smooth, rounded

impressions causing filling defects in barium studies of
ischemic colitis. These nodular densities represent
edema and hemorrhage into the wall of the colon
Seen in roughly 75% of cases of transient,
nongangrenous ischemic colitis.
 Resolve once the colon wall has been
reperfused and healed.
Pseudomembranous colitis, ulcerative colitis,
lymphoma, leukemia, and hemorrhage may
also produce the thumbprint sign.
FIGURE 18. (A) Thumbprint. (B) Plain radiograph of the abdomen in a
patient with ischemic colitis demonstrates thickening of the haustra
secondary to edema and hemorrhage resulting in the appearance of
multiple thumbprints in the wall of the colon
 Cobblestone sign

Classically seen within the small and large bowel on

fluoroscopic studies in the presence of active Crohns
disease.
This appearance is due to a combination of extensive,
broad, linear transverse and longitudinal ulcerations
within an inflamed mucosal surface. Only scattered
islands of normal mucosa remain in this setting
 The scattered islands can lead to the
misperception that the predominant ulcerated
regions are the baseline mucosa and the
normal mucosal islands are polyps.
The differential diagnosis for cobblestoning is
inflammatory polyposis in the setting of
inflammatory bowel disease.
FIGURE 19. (A) Cobblestones. Louisburg Square, Beacon Hill, Boston,
MA. (B) Radiograph of a small bowel follow-through in a patient with
Crohns disease demonstrates scattered islands of normal intestinal
mucosa adjacent to multiple ulcerations resulting in the cobblestone
appearance of the distal ileum.
 Bowler hat sign

Represents the appearance of a sessile

colonic polyp observed at an oblique angle
on a double contrast barium enema.
Formed by a ring of barium adjacent to the
base of the polyp surrounding a domed layer
of barium coating the surface of the polyp
 Bowler hat sign

A colonic diverticulum produce a bowler hat

appearance. The orientation of the dome of the
bowler hat sign can help differentiate a polyp
from a diverticulum.
An intraluminal polyp dome pointed inward
toward the lumen, while a diverticulum pointed
outward.
 FIGURE 20. (A) Bowler hat. Courtesy of Salmagundi, Jamaica
Plains, MA. (B) Radiograph from a double contrast barium enema
demonstrates a sessile polyp within the colon displaying the
appearance of a bowler hat.
 Radiographic model. (a) Radiograph of barium-coated cup shows superior bowler
hat (white arrow) pointing toward center of cup (ie, a polyp) and inferior bowler hat (black
arrow) pointing away from center of cup (ie, a diverticulum). (b) Radiograph obtained after
slight rotation of cup shows simulated polyp and diverticulum
 Mexican hat sign

Pedunculated colonic polyps form the Mexican hat

sign. These possess discrete stalks and observed en
face hanging from the nondependent wall of colon.
Formed by the 2 concentric rings;
The outer ring the en face barium coating the
surface of the head of a pedunculated polyp,
The inner ring a meniscus of barium surrounding
the stalk of the polyp visualized through the head
 FIGURE 21. (A) Mexican hat. Courtesy of the Border Caf,
Cambridge, MA. (B) Radiograph of an upper gastrointestinal
series demonstrates a pedunculated gastric polyp demonstrating
a close resemblance to a Mexican hat.
 Collar button sign
Manifestations of inflammatory processes the bowel.
These deep ulcerations seen in the colon
associated with active ulcerative colitis.
Formed by mucosal ulceration with associated
undermining of the ulcers edge by lateral submucosal
extension.
Vertical penetration into the bowel wall is limited the
resistance of the underlying muscularis mucosa.
Collar button ulcer observed such as Crohns
disease, ischemic colitis, and shigellosis.
 FIGURE 22. (A) Collar button. (B) Radiograph from a single
contrast barium that demonstrates a collar button appearance
 Apple core sign
The visual manifestation of an annular lesion of the
bowel with irregular overhanging edges and
shouldered margins.
Classically seen in colon carcinoma most commonly
located in the sigmoid colon
Differential diagnosis is focal diverticulitis, ischemic
colitis, ulcerative colitis, endometriosis, amebiasis,
serosal metastatic implants, infectious colitis and,
rarely, focal amyloidosis.
 FIGURE 23. (A) Apple core. (B) Fluoroscopic image from a double
contrast barium enema in a patient with changing bowel habits reveals an
annular lesion with overhanging edges within the colon closely
resembling an apple core.
 Accordion sign
The appearance of colonic wall thickening in the
setting of colitis.
Describes edematous haustral folds that are due to
transmural edema and are separated by transverse
mucosal clefts filled with oral contrast
Oral contrast is trapped between thickened,
edematous colonic folds and pseudomembranes
Has also observed with colonic edema secondary to
cirrhosis and in Crohns disease, ischemic colitis,
lupus vasculitis, and infectious colitis.
FIGURE 24. (A) Accordion. (B) Contrast-enhanced CT image of a patient
with Clostridium difficile enterocolitis demonstrates thickened haustra
secondary to transmural edema giving the transverse colon an
accordion-like appearance.
Accordion sign in a 50 year (submukosal edema
arrows,oral kontras material arrow head)
 Lead pipe sign

Classically seen with chronic, smoldering ulcerative

colitis.
Manifestation of multiple pathophysiological
processes.
There is increased regeneration colonic mucosa in
ulcerative colitis may lead to hypertrophy of the
muscularis mucosae.
Contraction of this hypertrophic muscle layer gives the
colon the lead pipe-like narrowed, ahaustral, and
foreshortened appearance
 Luminal narrowing caused by previously formed
strictures and fat distribution within the
submucosal layer of the bowel wall, particularly
the rectum
The differential diagnosis Crohns disease,
cathartic colon (which usually occurs in the
descending colon and spares the rectum),
tuberculosis, and, rarely, amebiasis.
FIGURE 25. (A) Lead pipe. (B) Radiograph from a double contrast
barium enema in a patient with chronic, smoldering ulcerative
colitis demonstrates an ahaustral, pipe-like appearance of the
colon.
Terima Kasih