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

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. We 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.