Lead pipe sign in mixed inflammatory bowel disease

Box 1 Other causes of loss of haustration 4 Crohn's colitis Cathartic colon Diversion colitis Dysenteries Tuberculous strictures Progressive systemic sclerosis Amyloid infiltration Table 1 Inflammatory bowel disease--- Crohn's disease Ulcerative colitis Site of origin Terminal ileum Rectum Pattern of progression and endoscopic findings Skip lesions, cobblestoning mucosa and aphthous or deep linear ulcers anywhere along the GI tract (usually rectal sparing) Proximally contiguous involvement of exclusively the colon, pseudopolyps Symptoms Crampy abdominal pain Bloody diarrhoea (haematochezia) Thickness of inflammation Transmural Mucosa and submucosa 3 Radiographic findings String sign on barium X-ray Lead pipe colon on X-ray Complications Fistulas, abscesses, obstruction Haemorrhage, toxic megacolon Surgery Used for complications (eg, strictures) Curative Risk of colon cancer Slightly increased risk Markedly increased risk Pathology Crypt abscesses (uncommon), granulomas, submucosal fibrosis and fissures Crypt abscesses (common) Serology Frequently ASCA+ Frequently p-ANCA+ ASCA, anti-Saccharomyces cerevisiae antibody; GI, gastrointestinal; p-ANCA, perinuclear anti-neutrophil cytoplasmic antibody.