Mallet-Guy's sign

Mallet-Guy's sign
Synonyms
Pronounce	N/A
Specialty	Gastroenterology
Symptoms	Pain in the epigastric region
Complications	N/A
Onset	N/A
Duration	N/A
Types	N/A
Causes	Chronic pancreatitis
Risks	N/A
Diagnosis	Clinical examination
Differential diagnosis	Other causes of epigastric pain
Prevention	N/A
Treatment	Management of underlying condition
Medication	N/A
Prognosis	Depends on the underlying cause
Frequency
Deaths	N/A

Mallet-Guy sign is a clinical sign observed in patients with acute or chronic pancreatitis. It is characterized by tenderness on deep palpation in the costovertebral angle on the left side, particularly in cases of left-sided peripancreatic inflammation. This sign was described by the French surgeon Pierre Mallet-Guy and is used as an indicator of pancreatic pathology.

Clinical Significance

The Mallet-Guy sign is elicited by deep palpation in the left costovertebral angle, where pain suggests irritation or inflammation of the pancreas, particularly affecting the retroperitoneal space. It is associated with:

• Acute pancreatitis
• Chronic pancreatitis
• Peripancreatic fluid collections
• Pancreatic pseudocyst
• Other retroperitoneal inflammatory processes

Mechanism

The pancreas, particularly the tail, is in close proximity to the left kidney and costovertebral region. Inflammation from pancreatitis can extend into the retroperitoneal space, leading to pain upon deep palpation in this region.

Differential Diagnosis

A positive Mallet-Guy sign may be seen in conditions other than pancreatitis, including:

• Renal pathologies (e.g., pyelonephritis, nephrolithiasis)
• Splenic involvement (e.g., splenomegaly, splenic infarction)
• Musculoskeletal pain (e.g., rib fractures, costochondritis)

Clinical Examination

To elicit the Mallet-Guy sign: 1. The patient is placed in a supine or slightly lateral position. 2. The examiner applies deep pressure in the left costovertebral angle. 3. A positive response occurs if the patient experiences tenderness localized to the retroperitoneal space.

Related Signs in Pancreatitis

Several other clinical signs may assist in diagnosing pancreatitis:

• Cullen's sign ‚Äì Periumbilical ecchymosis, indicating retroperitoneal hemorrhage.
• Grey Turner sign ‚Äì Flank ecchymosis, suggesting hemorrhagic pancreatitis.
• Fox's sign ‚Äì Ecchymosis over the inguinal ligament, seen in severe pancreatitis.
• Blumberg sign ‚Äì Rebound tenderness, indicating peritoneal irritation.

Diagnostic Utility

The Mallet-Guy sign is a clinical finding, but its sensitivity and specificity are limited. It should be correlated with:

• Laboratory tests ‚Äì Elevated serum amylase, lipase, inflammatory markers.
• Imaging studies ‚Äì CT scan, MRI, or ultrasound to evaluate pancreatic inflammation or fluid collections.

Clinical Implications

A positive Mallet-Guy sign should prompt further evaluation for pancreatic disease and possible retroperitoneal involvement. Early detection of pancreatitis or peripancreatic complications can improve management and prognosis.

See Also

• Acute pancreatitis
• Chronic pancreatitis
• Pancreatic pseudocyst
• Peritonitis
• Abdominal examination