![]() Plain film shows diffuse spasm and edema of the transverse colon due to extensive inflammatory exudate that also displaces the stomach superiorly and the transverse colon inferiorly.ĭiffuse inflammation of transverse colon, shown by spastic narrowing and gross mucosal irregularities on delayed film of upper GI series.ĭiffuse inflammation of transverse colon. Phlegmonous changes involve the anterior pararenal spaces bilaterally and extend across the mesocolon (arrows) toward the transverse colon (TC), which exhibits ileus. Fulminant acute pancreatitis extending through the transverse mesocolon. (b) The infiltrate compresses and distorts the transverse colonįig. (a) At the level of the uncinate process of the pancreas (P), inflammatory changes progress through the transverse mesoco-lon (arrows) toward the right, with associated conspicuous branches of the middle colic vessels. Extension of acute pancreatitis to transverse colon. Mesocolic involvement by pancreatitis.ĬT demonstrates multiple pseu-docysts of the pancreas (asterisks) have extended into the transverse mesocolon, whose fatty tissue is infiltrated by the inflammatory process.įig. (Courtesy of Emil Balthazar, M.D., Bellevue Hospital, New York University School of Medicine, New York, NY.)įig. Note that the process stops just short of affecting the transverse colon (TC). (b) Three months later, the process has condensed and become encapsulated as a small pseudocyst within the transverse mesocolon (arrow). (a) During an episode of acute pancreatitis, CT shows enlargement of the pancreatic head (P) and phlegmonous extension into the transverse mesocolon (arrows). Acute pancreatitis with extension in mesocolon approaching the transverse colon. Areas of fat necrosis were present in the transverse mesocolon, pericolonic tissue, and greater omentum.įig. Exploratory laparotomy disclosed a large peripancreatic abscess with retroperitoneal extension down to and involving the hepatic flexure and distal ascending colon, where an extramural inflammatory stricture was encountered. The constant narrowing and overhanging shelflike margin mimic an "apple-core" carcinoma. (a and b) Barium enema and spot film demonstrate an annular constricting lesion of the distal ascending colon. Acute suppurative pancreatitis with extension to hepatic flexure. More directly irritative effects may be manifested by spasm and edema18 (Figs. This often represents a paralytic ileus secondary to the extravasated enzymes within the transverse mesocolon (Figs. On plain films, the most common abnormality in the large intestine in cases of acute pancreatitis is gaseous distention of the transverse colon. Acute pancreatitis with extension to hepatic flexure.īarium enema shows diffuse mild spasm and edematous mucosal changes of the hepatic flexure and distal ascending colon from extension of extravasated pancreatic enzymes via the right anterior pararenal compartment. ![]() ![]() In my ex-perience,2 as well as that of others,14-17 this is by far the most common single site involved.įig. Brascho and co-authors13 found the gaseous dilatation to involve the ascending and entire transverse colon, with the cut-off point at the splenic flexure. This was a constant finding in both supine and erect plain films of the abdomen in six patients with acute pancreatitis. Stuart12 employed it to designate collapse with absence of gas in the midportion of the transverse colon, which appeared to be cut off from the gas-containing hepatic and splenic flexures. Since Price's report, however, the term "colon cut-off" sign has lost its original definition and has been applied to multiple sites of spasm and narrowing of the colon secondary to pancreatitis. ![]()
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