Colon cut-off sign

Case contributed by Dr Vikas Shah

Presentation

This man presented with abdominal distension and vomiting.

Patient Data

Age: 65
Gender: Male

Chest and abdomen

Modality: X-ray

The xrays show markedly dilated loops of small bowel, and a dilated transverse colon is seen on the chest xray. The chest xray is taken standing up (erect) and shows air-fluid levels in both the small and large bowel. On the abdominal xray, there is no gas seen in the large bowel beyond the splenic flexure. The upper abdominal xray shows an abrupt transition from distended to collapsed colon just beyond the splenic flexure. The findings indicate small and large bowel obstruction

A CT of the chest, abdomen and pelvis should be the next step as the findings are suspicious for a colonic malignancy.

Modality: CT

The CT confirms a tight stricture involving the proximal descending colon with marked proximal colonic distension.

Case Discussion

The colon cut-off sign has been described most commonly with acute pancreatitis, secondary to the inflammation extending to the splenic flexure via the phrenicocolic ligament. However, the degree of distension is not as much as in a true colonic stricture, with much of the small bowel distension in pancreatitis being due to an ileus. If you see this pattern of xray findings in somebody with abdominal distension without features of acute pancreatitis, a malignant stricture should be suspected and CT of the chest, abdomen and pelvis arranged.

 

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Case Information

rID: 31102
Case created: 19th Sep 2014
Last edited: 13th Aug 2016
Inclusion in quiz mode: Included

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