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Case of the Week 352

What's the most likely diagnosis?

  • 75 year-old with abdominal pain; the sign shown is called the:

Supine radiograph of abdomen (disregard the gallstones)

  1. Pawnbroker's sign
  2. Sigmoid elevator sign
  3. Crescent sign
  4. Rigler's sign
  5. Colon cutoff sign

Additional Image - Contrast-enhanced CT of abdomen


Additional Image



Contrast-enhanced CT of upper abdomen




5. Colon cutoff sign (here shown in mesenteric ischemia



More (Click Discussion Tab)

Colon Cutoff Sign

General Considerations

  • The pattern of bowel gas in which there is air in a slightly dilated  transverse colon up to, but not beyond, the splenic flexure
  • Originally described on conventional radiography, it has the same appearance and implications on CT
  • In pancreatitis, the disease in which it was described, it is caused by inflammatory exudate from the pancreas which infiltrates the transverse mesocolon via the phrenicocolic ligament
    • The phrenicocolic ligament is a peritoneal fold extending from the splenic flexure to the posterolateral aspect of the left hemidiaphragm
    • The spleen rests on the shelf formed by this ligament
  • This produces spasm of the transverse colon or actual physical narrowing of the splenic flexure

More ...


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