Anterior extension of acute pancreatitis: CT findings

Abstract

Objective: The purpose of this study is threefold: (a) to specify the pathway of the extension of pancreatitis to the anterior abdominal wall, which is clinically famous as the Cullen sign; (b) to assess if this pattern of involvement affects a patient's prognosis; and (c) to seek its association with the inflammatory processes that take place in the vicinity of the pancreatic head.

Materials and methods: The CT findings of 277 patients with acute pancreatitis were retrospectively reviewed.

Results: Inflammatory changes involved the anterior abdominal wall in 5 of 277 cases (1.8%) with acute pancreatitis. Inflammatory processes seemed to have been delivered to the anterior abdominal wall from the pancreatic head and the hepatoduodenal ligament and along the falciform ligament. The probable triggers of acute pancreatitis in such cases were endoscopic retrograde cholangiopancreatography in two cases, alcohol intake in one case, and one case unknown. Three of five cases had proven or suspected choledocholithiasis or cholelithiasis. All five patients got well after proper treatments for acute pancreatitis.

Conclusion: The results of our review suggest that the anterior extension of acute pancreatitis does not directly mean extensive retroperitoneal involvement of the phlegmon or pseudocysts nor fatal prognosis either and that this style of extension might be associated with inflammatory processes that occur around the pancreatic head.