Which radiographic signs on abdominal X-ray are associated with pancreatitis?

• A. Sentinel loop sign and colon cutoff sign
• B. Free air under the diaphragm
• C. Calcifications in the gallbladder
• D. Dilation of the small bowel

Answer: (A)

Pancreatitis can cause a localized ileus around the inflamed pancreas, which on an abdominal X-ray may present with two classic signs. The sentinel loop is a single, dilated loop of small bowel that appears in the area near the pancreas, reflecting irritation and slowed movement from nearby inflammation. The colon cutoff sign occurs when gas in the colon abruptly ends at the splenic flexure due to the inflammatory process irritating the colon and interrupting its motility. Together, these signs point to pancreatic inflammation when seen with compatible symptoms, though they are not highly sensitive and imaging like ultrasound or CT is more definitive for pancreatitis.

Free air under the diaphragm suggests perforation, not pancreatitis. Calcifications in the gallbladder indicate gallstones or chronic gallbladder disease, which can be related to pancreatitis but don’t itself diagnose pancreatitis on imaging. Dilation of the small bowel is a nonspecific finding that can occur with many causes of ileus or obstruction and isn’t specific to pancreatitis.