Solution: This case is a great example of a "lead pipe" colon. As you know, ulcerative colitis is an idiopathic disease of variable severity from long-term severe disease to a single symptomatic episode. It is associated with diarrhea, rectal bleeding, weight loss, tenesmus, and systemic symptoms. Considerable information can be gained by careful scrutiny of the plain films in many cases. The colon in this case is narrowed and featureless, a common finding in relatively severe cases and described as the "lead pipe" colon. Associated findings can include, renal calculi, sacroiliitis, ankylosing spondylitis and avascular necrosis of the femoral heads. None of these are present in this case. Barium enema can be helpful for diagnosis (acute findings include mucosal granularity and stippling, ulcers, haustral thickening inflammatory polyps and confluent, contiguous circumferential disease. Chronic changes include haustral loss, luminal narrowing, widened presacral space, inflammatory pseudopolyps and backwash ileitis. Management of UC is complex and can include medications or ultimately colectomy depending upon the severity of disease.