ANTERIOR EXTENSION OF ACUTE-PANCREATITIS - CT FINDINGS

Objective: The purpose of this study is threefold: (a) to specify the pathway of the extension of pancreatitis to the anterior abdominal wal l, which is clinically famous as the Cullen sign; (b) to assess if thi s pattern of involvement affects a patient's prognosis; and (c) to see k its association with the inflammatory processes that take place in t he vicinity of the pancreatic head. Materials and Methods: The CT find ings of 277 patients with acute pancreatitis were retrospectively revi ewed. Results: Inflammatory changes involved the anterior abdominal wa ll in 5 of 277 cases (1.8%) with acute pancreatitis. Inflammatory proc esses seemed to have been delivered to the anterior abdominal wall fro m the pancreatic head and the hepatoduodenal ligament and along the fa lciform 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 case s had proven or suspected choledocholithiasis or cholelithiasis. All f ive patients got well after proper treatments for acute pancreatitis. Conclusion: The results of our review suggest that the anterior extens ion of acute pancreatitis does not directly mean extensive retroperito neal involvement of the phlegmon or pseudocysts nor fatal prognosis ei ther and that this style of extension might be associated with inflamm atory processes that occur around the pancreatic head.