http://ijdi.sciedupress.com International Journal of Diagnostic Imaging 2018, Vol. 5, No. 1 CASE REPORTS A variation of colon cut off sign in acute pancreatitis and its mechanism: Double cut-off sign Nisa Cem Ören * , Osman Cancuri, Murat Kocaoğlu, Nail Bulakbaşı Department of Radiology, Faculty of Medicine, Near East University, Nicosia, North Cyprus Received: April 25, 2017 Accepted: August 7, 2017 Online Published: August 30, 2017 DOI: 10.5430/ijdi.v5n1p1 URL: https://doi.org/10.5430/ijdi.v5n1p1 ABSTRACT The colon cutoff sign is a single air-filled loop of transverse colon with abrupt termination of the distal colon. We report an acute pancreatitis case with colon “double” cut-off sign appears both on abdominal radiograph and computed tomography. Key Words: Signs in imaging, Computed tomography (CT), Colon, Pancreatitis 1. I NTRODUCTION The classical colon cutoff sign is a dilated, air-filled trans- verse colon due extension of the pancreatic inflammation to the phrenicocolic ligament which causes narrowing of the splenic flexure and gasless colon beyond this point. This find- ing was described on the abdominal X-ray, but a similar sign has also been observed on the CT scanograms. [1, 2] This sign was originally described in acute pancreatitis but can also be seen in patients with gastric cancer, ureteric rupture, and abdominal aortic aneurysm rupture presumably secondary to subperitoneal spread of disorders. [1, 3] Spreading the peri- pancreatic inflammation through phrenicocolic ligament is the reason of colon cut-off sign; however, but spreading of the inflammatory exudates through the subperitoneal spaces may cause this sign, as well. We report an acute pancreatitis case whose abdominal radiography and computed tomogra- phy (CT) displayed two distended colonic segment- colon “double” cutoff sign-, one at the end of the transverse colon and the second one at the beginning of the descending colon as a result of spreading of peripancreatic inflammation. 2. CASE REPORT A 21-year-old male with a past medical history of acute pancreatitis and hyperlipidemia admitted to the emergency department with the complaints of severe epigastric pain unresponsive to H2-receptor blockers and analgesics. Lab- oratory test, an abdominal radiograph and CT scan were ordered with the suspicion of acute pancreatitis. Initial labo- ratory results showed that CRP 20.09 mg/dl (normal range 0-0.5 mg/dl), pancreatic amylase 194 U/L (normal range 13-53 U/L), lipase 529 U/L (normal range 13-60 U/L), total cholesterol 1,011 mg/dl (normal range 0-200 mg/dl), and triglyceride 4,646 mg/dl (normal range 0-150 mg/dl). The abdominal radiograph demonstrated two distended colonic loops at the left transverse colon and proximal descending colon and abrupt termination at the end of these gas-filled colonic segments (see Figure 1). An abdominal multidetector CT was obtained following intravenous (iv) contrast media. No oral or rectal contrast media were given. The CT scan was obtained at the arterial and portal venous phase and re- constructed images at different planes were examined. The CT scanograms confirmed the distended two colon loops, * Correspondence: Nisa Cem Ören; Email: cemorenradiologist@gmail.com; Address: Department of Radiology, Faculty of Medicine, Near East University, Nicosia, North Cyprus. Published by Sciedu Press 1