Early localization of necrosis by contrast-enhanced computed tomography can predict outcome in severe acute pancreatitis

Abstract

A total of 161 primary contrast-enhanced computed tomography (CT) scans of patients with acute necrotizing pancreatitis taken between 1982 and 1994 were analysed retrospectively. The aim was to assess the prognostic significance of the extent and anatomical site of pancreatic tissue necrosis in the first contrast-enhanced CT scan. The scans were obtained a mean of 2.9 days after the onset of symptoms. The pancreatic head was affected in 107 patients, the body in 119 and the tail in 138. Pancreatic tissue necrosis, when divided into four groups according to anatomical site, correlated with overall clinical outcome. The anatomical site of necrosis was clearly better than its crude extent in predicting the risk of complications. For patients with necrosis in the head of the pancreas, the outcome was as severe as when the entire pancreas was affected. In contrast, for patients with necrosis only in the distal part of the pancreas, the outcome was favourable with few complications. The exact site of pancreatic tissue necrosis should be known when early contrast-enhanced CT is used in prognostic scoring.

Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis

“…Atlanta criteria overlook the amount and location of necrosis on CECT [7] . However, Kemppainen et al [18] showed that, the outcome was favorable for patients with necrosis restricted to the distal part of the pancreas. CECT may yield negative findings in 20%-30% of the mild AP patients.…”

Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?

“…Indeed, the risks of acute pancreatitis are most of all infectious complications that are directly linked to the presence of necrosis, a favourable environment to the development of bacteria [3,7,[19][20][21][22][23][24][25][26][27][28]. The overall risk of infection does not exceed 10%, but in case of necrosis, it reaches 70%.…”

Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection

“…The principle benefit of early correct assessment of severity in AP is that patients who require intensive monitoring and therapy are detected at once. The role of clinical assessment is reliable but for its subjectivity the value in the early detection of severity is limited [1,6] . C-reactive protein (CRP) is a promising laboratory marker of severity, even though it is not specific for AP [1] .…”

“…The spectrum of acute pancreatitis (AP) ranges from a mild spontaneously resolved disorder to severe disease with a mortality up to 20%-48.4% [1][2][3] . sAP is defined as the AP with organ failure and/or local complications which developed from acute fluid collection (AFC) including necrosis, abscess, pseudocyst formation into or around the pancreas [4] .…”

“…C-reactive protein (CRP) is a promising laboratory marker of severity, even though it is not specific for AP [1] . Single or multiple biochemical criteria and different scoring systems have been used as prognostic indicators, but none has been proven satisfactory in clinical practice [1,6] . The aim of this study is to investigate the prognostic significance of evaluating the severity of AP by observing AFC using ultrasonography.…”