CASE REPORT

28         SA JOURNAL OF RADIOLOGY • March 2006

A variety of pips and chewed nuts can simulate disease by appearing 

as multiple filling defects on the double-contrast barium enema. The 

unwary and untrained eye might interpret these filling defects as mul-

tiple polyps, leading to the wrong diagnosis and unnecessary further 

investigations or treatment. 

A case of multiple linseeds mimicking polyposis coli on double-

contrast barium enema has been described by Petty and Mannion.1  The 

following similar cases were noted.

Case 1. A 73-year-old woman presented with abdominal pain. A 

double-contrast barium enema showed multiple pointed oval-shaped 

filling defects (Fig. 1a, white arrows). On retrospective enquiry, the 

patient confirmed taking linseed regularly for constipation and also 

ingested grapes during the 3 days prior to the examination. The filling 

defects noted were not consistent with linseed size and shape, and most 

likely represent filling defects from grape seed. To simulate the picture of 

linseed and grape pip filling defects, linseeds (Figs 1b and c), grape pips 

(Fig. 1d) and liquid barium were placed in latex surgical gloves and X-

rayed to simulate double-contrast barium study. Prior to the study, the 

linseeds and grape pips were soaked overnight in tepid water to account 

for natural seed swelling occurring during bowel transit. 

Case 2: Two cases of mealie pips simulating polyps (Figs 2a - c,  

white arrows) were seen during double-contrast barium enema studies. 

Both male patients confirmed ingestion of mealies prior to the investi-

gation.

Case 3: A 54-year-old-female patient underwent a double-contrast 

barium enema study for rectal bleeding and change in bowel habits fol-

Potential pitfalls – pips or polyps? 

I van de Werke, FRCR

A T du Plessis, MB ChB 

Department of Radiology, Kalafong Hospital, University of Pretoria 

Z Lockhat, FFRad (D)

Department of Radiology, Pretoria Academic Hospital, University of Pretoria

Fig. 1a. Grape pips (arrows) simulating polyps.

PICTORIAL INTERLUDE

Fig. 1b. Multiple linseed shadows during simulation in latex glove.

Fig. 1c. Multiple linseed shadows during simulation in latex glove.

Fig. 1d. Multiple grape pip shadows during simulation in latex glove.

28         SA JOURNAL OF RADIOLOGY • March 2006

PICTORIAL INTERLUDE

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lowing strangulated incisional hernia repair. Multiple small, irregular 

filling defects (Fig. 3, white arrows) were noted in the dependent parts 

of the colon. The patient confirmed that large amounts of cashew nuts 

were ingested during the 2 days prior to the investigation. 

As illustrated by the above cases, seed and pip filling defects mim-

icking multiple polyps must be kept in mind when interpreting double-

contrast barium enema studies. This underlines the importance of 

proper history taking and retrospective enquiry about the dietary habits 

of patients, after identifying such filling defects during interpretation of 

double-contrast barium enema studies.

1.  Petty D, Mannion R. Case of multiple linseeds mimicking poliposis coli on double contrast barium 

enema. Clin Radiol 2003; 58: 87-88.

Fig. 2b. Mealie pips (arrows) simulating polyps.

Fig. 3. Chewed cashew nuts (arrows) simulating polyps.Fig. 2c. Mealie pips (arrows) simulating polyps.

Fig. 2a. Mealie pips (arrows) simulating polyps.

PICTORIAL INTERLUDE

29         SA JOURNAL OF RADIOLOGY • March 2006

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