CT findings and features of postoperative abdominal infection patients with pancreatic carcinoma

Abstract

Objective:To investigate the values of Computed Tomography (CT) in diagnosing postoperative pancreatic surgeryabdominalinfection and its efficacy and to provide a reasonable method for the diagnosis of abdominal infection.Methods:Seventy-two patients who were confirmed as resectablepancreatic carcinoma by physical examination, CT, positron emission tomography (PET)/CT, endoscopic retrograde cholangiopancreatography (ER-CP), endoscopic ultrasonography and mesenteric angiography and were admitted to the Binzhou People’s Hospital, Shandong, China, from July 2013 to July 2015 were randomly selected. The plain CT images and clinical data of the patients were retrospectively analyzed.Results:Among 72 patients, 32 patients were diagnosed as abdominal infection by CT, three patients were misdiagnosed (two cases of intestinal obstruction and one case of intraperitoneal abscess), and 2 patients were wrongly diagnosed as suppurative abdominal inflammation. As regards distribution of CT imaging positive performance, the number of patients with intestinal loop abscess accounted for 41.7%, subphrenic abscess for 16.7%, pelvic abscess for 33.3%, the existence of septation for 25%, and emphysema sign for 16.7%. As to the distribution of CT findings of intestinal obstruction, 46.1% of patients had dilatation of intestine, 30.8% for bowel wall thickening, 7.7% had abnormal enhancement, 11.1% had density abnormality, and 15.4% had mesenteric effusion. CT features of purulent peritonitis showed 57.1% of patients had peritoneal thickening, 42.9% had peritoneal effusion, 42.9% had free intraperitoneal air, 14.3% had intestinal walls edema, and 28.6% had mesenteric edema.Conclusion:The diagnosis of postoperative abdominal infection of patients with pancreatic carcinoma using CT is quick and efficient showing the pattern and distribution of collection and the gross reaction to the exciting infection.

The Clinical Implications of Peripancreatic Fluid Collection After Distal Pancreatectomy

“…Clinical symptoms indicative of POPF cases include abdominal pain, fever, purulent discharge, and inflammatory markers in blood tests. Computed tomography (CT) is the most useful modality for screening of abdominal events during DP including abdominal abscess, free air, inflammation, and bleeding [5][6][7], and has often revealed peripancreatic fluid collection (FC) postoperatively [8][9][10]. Some FCs require invasive treatments if a high amylase level is demonstrated on reaspiration, because it indicates delayed pancreatic fistula [11], while other FCs do not cause any clinical problems and can go untreated.…”

Diagnostic challenges in postoperative intra-abdominal sepsis in critically ill patients: When to reoperate?

“…Computed tomography (CT) scan is considered the diagnostic gold standard for both secondary and ongoing peritonitis, with diagnostic sensitivity of 97.2% [36]. Laparatomy has been considered one of the most routine diagnostic techniques for postoperative intra-abdominal sepsis [37]. However, this technique presents the risk of the development of acute abdominal compartment syndrome (ACS), recognized by peritonitis, capillary leakage, and fluid resuscitation [37,38].…”

“…Laparatomy has been considered one of the most routine diagnostic techniques for postoperative intra-abdominal sepsis [37]. However, this technique presents the risk of the development of acute abdominal compartment syndrome (ACS), recognized by peritonitis, capillary leakage, and fluid resuscitation [37,38]. Documented data reported that when CT and abdominal ultrasound are not available, diagnostic peritoneal lavage may be useful for the diagnosis of postoperative intra-abdominal sepsis [39].…”