What causes Moulage sign in small bowel on barium follow-through?
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Answer:
Moulage sign represents a smooth, featureless, dilated jejunal loop with complete effacement of mucosal folds seen in celiac sprue (celiac disease), a malabsorptive disorder triggered by gluten exposure in genetically susceptible individuals.
Why is it called so?
The term “moulage” derives from the French word for a cast or mold made by pouring wax into a mold, describing the smooth, tubular appearance of the dilated bowel resembling a wax cast with loss of surface detail.
Pathophysiology
Chronic gluten-induced villous atrophy and intraepithelial lymphocytosis lead to mucosal flattening and effacement of jejunal folds (valvulae conniventes), resulting in a flaccid, dilated loop that fills uniformly with barium, producing the featureless “cast-like” contour without fold pattern.
Alternative names: none
Other associated named signs: Reversal of the jejunoileal fold pattern (jejunoileal fold pattern reversal) and jejunization of the ileum, both reflecting ileal compensatory hypertrophy in celiac disease; also loosely termed “colonization of the jejunum,” where the jejunum comes to resemble the colon after loss of its normal fold pattern.
References
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