Question 1: The 'claw sign' in barium enema study favours the diagnosis of :
- A. Sigmoid volvulus
- B. Crohn's disease
- C. Gastro colic fistula
- D. Intussusception (Correct Answer)
Explanation: ***Intussusception***
- The **"claw sign"**, or sometimes called the **"crescent sign"** or **"meniscus sign,"** on a barium enema is indicative of intussusception, where the contrast material fills the space between the intussusceptum and intussuscipiens, creating a claw-like appearance.
- This sign represents the barium outlining the leading edge of the **intussusceptum** as it telescopes into the more distal bowel.
*Sigmoid volvulus*
- Sigmoid volvulus typically presents with a **"coffee bean sign"** or **"omega loop sign"** on plain abdominal radiographs due to the massively dilated, air-filled sigmoid colon.
- Barium enema in sigmoid volvulus would show a **"bird's beak"** or **"ace of spades"** appearance at the site of the twist, representing the tapered narrowing.
*Crohn's disease*
- Crohn's disease is characterized by various findings on barium studies, such as **"skip lesions,"** **cobblestoning**, and **ulcerations**, but not a claw sign.
- Strictures, fistulas, and thickened bowel walls are also common in Crohn's disease, creating different radiological patterns.
*Gastro colic fistula*
- A gastrocolic fistula is an abnormal connection between the stomach and the colon, most commonly seen in advanced gastric carcinoma or Crohn's disease.
- On barium enema or upper GI series, it would be identified by the direct visualization of contrast flowing from the colon into the stomach or vice versa, not by a claw sign.