CT imaging, classification, and complications of acute pancreatitis

Fung, Christopher; Svystun, Orysya; Fouladi, Daniel Fadaei; Kawamoto, Satomi

doi:10.1007/s00261-019-02236-4

Cited by 26 publications

(15 citation statements)

References 41 publications

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“…It has been reported that in the acute phase of acute pancreatitis, even within 72 hours of symptom onset, CT scan is not superior to the clinical scoring system. This is because imaging may underestimate the extent or severity of pancreatic/peripancreatic necrosis [4,21]. Typical CT features were found in 10 patients in our study.…”

Section: Discussionmentioning

confidence: 56%

Risk factors and Diagnostic Indicators for postoperative acute pancreatitis in acute aortic dissection

Liu

Fang

et al. 2023

Preprint

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Objectives: To analyze the incidence, prognosis, risk factors and diagnostic indicatorsof postoperative acute pancreatitis (PAP) in cases of acute type A aortic dissection (ATAAD). Methods: We enrolled 639 patients with ATAAD who underwent thoracic aortic endovascular repair or open surgery at our center from January 2019 to October 2021, and reported the perioperative information. Once patients were diagnosed with PAP, we recorded the diagnostic features, including acute severe epigastric abdominal pain, pancreatic enzyme levels, and abdominal computed tomography or ultrasonography results. Results: PAP in cases of ATAAD was present in 13 patients (13/639, 2.04%), who had a higher proportion of postoperative complications and worse prognosis. The incidences of postoperative hypoxemia [12 (92.31%) vs. 196 (31.31%)], low cardiac output syndrome [2 (15.38%) vs. 13 (2.08%)], need for renal-replacement therapy (RRT) [7 (53.85%) vs. 116 (18.53%)], pneumonia [8 (61.54%) vs. 80 (12.78%)], and bacteremia [5 (38.46%) vs. 27 (4.31%)] were higher in patients with PAP than in the control group. The 90-day mortality of postoperative PAP was 30.77% (4/13). Logistic regression analysis identified coronary and/or atherosclerosis (OR: 7.768, 95%CI [1.463- 41.261], p=0.016), postoperative hypoxemia (OR: 24.429, 95%CI[2.003-298.008, p=0.012), low cardiac output syndrome (OR: 27.382, 95%CI [1.65-454.271, p=0.021), and lactate dehydrogenase level (OR: 1.021, 95%CI [1.005- 1.037], p=0.01) as significant independent risk factors for PAP. Severe epigastric pain is the main manifestation of PAP in ATAAD patients. Conclusions: PAP is a serious complication of ATAAD and is associated with poorer outcomes. Coronary and/or atherosclerosis, postoperative hypoxemia, low cardiac output syndrome, and higher lactate dehydrogenase levels are risk factors for PAP. In cases of progressively elevated pancreatic enzymes or positive abdominal symptoms, a computed tomography scan or magnetic resonance imaging should be performed immediately to rule out PAP.

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Section: Discussionmentioning

confidence: 56%

Risk factors and Diagnostic Indicators for postoperative acute pancreatitis in acute aortic dissection

Liu

Fang

et al. 2023

Preprint

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“…Nonionic intravenous contrast material was injected at a bolus of 3–5 mL/s with a total volume of 100–120 ml before scanning. All patients underwent unenhanced imaging followed by arterial phase (25–30 s) and venous phase (60 s) imaging after infusion of contrast material [ 9 ]. Encapsulation was defined as a continuous enhancing wall around peripancreatic fluid/necrosis collections on CECT ( Fig.…”

Section: Methodsmentioning

confidence: 99%

Early encapsulation of peripancreatic fluid/necrosis collections on imaging (CECT) in acute pancreatitis: influential factors and clinical significance for prognosis

Ning,

Yu,

Sun

et al. 2024

BMC Gastroenterol

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Background To identify the factors influencing the early encapsulation of peripancreatic fluid/necrosis collections via contrast-enhanced computed tomography (CECT) and to determine the clinical significance of early encapsulation for determining the prognosis of acute pancreatitis (AP) patients. Methods AP patients who underwent CECT between 4 and 10 days after disease onset were enrolled in this study. Early encapsulation was defined as a continuous enhancing wall around peripancreatic fluid/necrosis collections on CECT. Univariate and multivariate logistic regression analyses were performed to assess the associations between the variables and early encapsulation. Clinical outcomes were compared between the non-encapsulation and early encapsulation groups with 1:1 propensity score matching. Results A total of 289 AP patients were enrolled. The intra-observer and inter-observer agreement were considered good (kappa statistics of 0.729 and 0.614, respectively) for identifying early encapsulation on CECT. The ratio of encapsulation increased with time, with a ratio of 12.5% on day 5 to 48.7% on day 9. Multivariate logistic regression analysis revealed that the longer time from onset to CECT examination (OR 1.55, 95% CI 1.23–1.97), high alanine aminotransferase level (OR 0.98, 95% CI 0.97–0.99), and high APACHE II score (OR 0.89, 95% CI 0.81–0.98) were found to be independent factors associated with delayed encapsulation. The incidence of persistent organ failure was significantly lower in the early encapsulation group after matching (22.4% vs 6.1%, p = 0.043). However, there was no difference in the incidence of infected pancreatic necrosis, surgical intervention, or in-hospital mortality. Conclusions AP patients without early encapsulation of peripancreatic fluid/necrosis collections have a greater risk of persistent organ failure. In addition to longer time, the high APACHE II score and elevated alanine aminotransferase level are factors associated with delayed encapsulation.

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“…Vascular complications occur in approximately 25% cases with AP. 3 The vascular complications occurring could be arterial or venous. Arterial complications include PSA, active extravasation, arteritis, and arterial fistula.…”

Section: Summary Of the Evidencementioning

confidence: 99%

Indian College of Radiology and Imaging Consensus Guidelines on Interventions in Pancreatitis

Gupta

Madhusudhan

Padmanabhan

et al. 2022

Indian J Radiol Imaging

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Acute pancreatitis (AP) is one of the common gastrointestinal conditions presenting as medical emergency. Clinically, the severity of AP ranges from mild to severe. Mild AP has a favorable outcome. Patients with moderately severe and severe AP, on the other hand, require hospitalization and considerable utilization of health care resources. These patients require a multidisciplinary management. Pancreatic fluid collections (PFCs) and arterial bleeding are the most important local complications of pancreatitis. PFCs may require drainage when infected or symptomatic. PFCs are drained endoscopically or percutaneously, based on the timing and the location of collection. Both the techniques are complementary, and many patients may undergo dual modality treatment. Percutaneous catheter drainage (PCD) remains the most extensively utilized method for drainage in patients with AP and necrotic PFCs. Besides being effective as a standalone treatment in a significant proportion of these patients, PCD also provides an access for percutaneous endoscopic necrosectomy and minimally invasive necrosectomy. Endovascular embolization is the mainstay of management of arterial complications in patients with AP and chronic pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the percutaneous management of complications of pancreatitis.

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CT imaging, classification, and complications of acute pancreatitis

Cited by 26 publications

References 41 publications

Risk factors and Diagnostic Indicators for postoperative acute pancreatitis in acute aortic dissection

Risk factors and Diagnostic Indicators for postoperative acute pancreatitis in acute aortic dissection

Early encapsulation of peripancreatic fluid/necrosis collections on imaging (CECT) in acute pancreatitis: influential factors and clinical significance for prognosis

Indian College of Radiology and Imaging Consensus Guidelines on Interventions in Pancreatitis

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