Colon-Cut-off-Sign in the CT- Scanogram – Evidence of Pancreatitis?

Abstract

A 53-year-old male patient was hospitalized with progressive upper abdominal pain. Physical examination findings: abdomen soft, no tenderness, no guarding, physiological peristaltic sounds. Laboratory results showed leukocytosis as well as elevated CRP, lipase and amylase. On the basis of the pronounced clinical symptoms, the patient was admitted to the department of internal medicine with the suspected diagnosis of a pancreatitis. As a result of pain exacerbation and an endoscopic examination in the area of the left flexure, the patient was referred to the department of radiology for a CT-scan of the abdomen. The abdominal CT was performed with oral contrasting of the gastrointestinal tract with water and rectal contrasting of the bowel with diluted gastrograffin as well as intravenous contrast medium (portal-venous phase, 3 mm slice thickness). The CT-scanogram showed an over-inflation of the transverse colon as well as the termination of contrast medium filling of the colon at the level of the left flexure [Table/ Fig-1]. In comparison, the descending colon and the sigmoid colon showed a normal contrast medium filling. A review of the Spiral-CT revealed a thickening of the colon wall in the area of the left flexure and peripancreatic fluid flows [Table/ Fig-2], which spread out caudally along the renal fasciae. The pancreas itself did not show any necrotic areas. A stenosing colonic tumour in the area of the left flexure was ruled out. Free intra-abdominal air was not detected. An ileus-typical distribution of bowel gas was not present either. One of the less considered but radiologically characteristic signs in conventional radiographic imaging of the abdomen in acute pancreatitis is the so-called colon-cut-off-sign. This sign refers to the abrupt termination of gas filling of the colon at the level of the left flexure. The more distal part of the colon usually shows a markedly reduced or a lack of gas filling. This bowel gas distribution, which feigns a constriction of the colon at the left flexure, has been observed within the context of acute pancreatitis for over 50 years. The frequency and sensitivity of the Colon-cut-off-sign fluctuate considerably in different studies. It can also be demonstrated in computed tomography (CT) and in the retrograde contrast medium filling of the colon. Keywords: Radiological signs, CT, Exudative pancreatitisWe report on a patient who was admitted to the department of internal medicine with pronounced, progressive upper abdominal pain, combined with fever, elevated CRP, lipase and amylase, and leukocytosis, with suspected pancreatitis. Colonoscopy was interrupted due to stenosis in the area of the left flexure, a stenosing tumour being suspected. Over the course of further diagnostics, the scanogram of the abdominal CT already showed a colon-cut-off-sign. In addition, exudative pancreatitis with a stenosing process in the area of the left colonic flexure was found. A solid tumour could be ruled out in repeated endoscopy.[table/ Fig-1 Under abstinence from food and with an...

Gastrointestinal tract involvement in acute pancreatitis: initial findings and follow-up by magnetic resonance imaging

“…In this study, we also found some AP patients had dilatation of the gastrointestinal tract with gas. But it was a nonspecific finding and can occur in various diseases (41).…”