'the fat-encrusted colon': A radiological abnormality of colonic mucosa occurring in patients with steatorrhoea

The clinical and radiological features of six cases of fat-encrusted colon are described. In patients with steatorrhoea, despite standard colonic preparation, fat may adhere to colonic mucosa and produce a radiological appearance that simulates the changes of inflammatory bowel disease. Steatorrhoea was due to coeliac disease in five patients, the sixth being a case of primary sclerosing cholangitis. The initial radiological diagnosis at barium enema in all six patients was of inflammatory bowel disease. On the basis of this appearance surgery was advised in three patients, one of whom proceeded to laparotomy with a view to colectomy. The correct diagnosis can be established by familiarity with the radiological appearance and confirmed by repeating the barium enema examination after 5 days of a fat-free diet, when the colonic mucosal pattern returns to normal.