Obliteration of thumbprinting with double-contrast enemas in acute ischemic colitis

Abstract

Three cases of transient ischemic colitis are described in which the typical thumbprinting sign was obliterated by air insufflation during double-contrast barium enema examination. The causes of this sign, the possible mechanism of its loss during double-contrast enema, and implications of this are discussed.

Ischemic Disease

“…Double-contrast barium studies characteristically show thumb-printing and longitudinal ulcers (hDA et al 1986). Loss of thumb printing may occur with air insufflation on the double-contrast barium examination but this finding will usually be evident at some stage during the examination, often during the filling stage (BARTRAM 1979). Rarely the mucosal abnormality will be extensive and resemble an inflammatory or infectious colitis (SCHOLZ 1993).…”

Ischemic Colitis

“…They may disappear after 48-72 h [2], and in the double contrast examination, these appear as polypoid masses. However, the double contrast study can also obliterate thumbprinting [67], Transverse ridging may also be seen and re sults from transverse spasms of the colonic musculature [68]. One to 3 weeks after the initial symptoms, mucosal ulcerations may become evident and have been described as a ragged sawtooth irregularity of the mucosa [ 1], Tubular narrowing as a result of stricture formation may take place from 3 weeks to 12 months after the onset of the ischemic epi sode [1], Sacculation may be seen and con sists of pscudodiverticulum formation on the antimesenteric side of the colonic wall.…”