Identification of pancreas necrosis in severe acute pancreatitis: imaging procedures versus clinical staging.

Abstract

SUMMARY One hundred and five of 395 patients with acute pancreatitis were surgically treated in our clinic from 1981 to 1984. Ninety three of these patients were examined with contrast enhanced computed tomography and/or ultrasound and were clinically assessed according to Ranson's objective criteria before operation. At operation, 77 patients showed necrotising pancreatitis and 16 showed biliary acute interstitial pancreatitis. Ninety per cent of the cases with extensive and 79% of those with minor necroses of the pancreas had been demonstrated with contrast enhanced computed tomography. Ultrasound failed to be diagnostic in 24% of the patients due to meteorism; the sensitivity of the diagnostic studies for pancreatic necrosis was 73% regardless of the extent of the process. Using the early objective signs, seven patients with acute interstitial pancreatitis were classified as having a severe attack, whereas 30 patients with necrotising pancreatitis were categorised as mild attacks. We conclude that the contrast enhanced computed tomography is an aid in deciding on conservative or surgical treatment in a case of acute pancreatitis. Ultrasound does not appear to be an adequate method for determining pancreatic necrosis. The early objective signs fail to sufficiently identify the necrotising form of acute pancreatitis.Even severe cases of acute pancreatitis can be cured by medical therapy if they are restricted to interstitial inflammation. Necrotising pancreatitis, however, holds a high risk of local infection and generalised sepsis and can, if it involves larger areas of the pancreas, lead to retroperitoneal tissue invasion and progressive toxic organ complications. 1-3 These complications could be avoided by the surgical removal of necrotic tissue and exudate.2-This in turn poses the problem of identifying and quantifying the necrosis of the pancreas in time for a successful operation. We therefore conducted a prospective clinical study in which the capacity of contrast enhanced computed tomography, ultrasound, and early objective signs7 to assess necrotising pancreatitis was determined by comparing the

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 C-reactive protein levels increase the accuracy of the Ranson score in predicting the severity and prognosis of acute pancreatitis? A prospective cohort study

“…A CT is the most frequently used radiological investigation to evaluate AP and detect necrosis. Intravenous contrast-enhanced CT distinguishes pancreatic necrosis with an accuracy of 90% (11). Several CT scoring systems have been reported as being better than other systems for predicting the severity of AP.…”

“…The CRP test is widely available in laboratories, and various researchers have suggesting using CRP as a prognostic marker for severe AP (9). However, a primary problem is the lack of specificity to predict severe AP at a level not greater than 80% (2,10,11).…”

A prospective study of clinical, biochemical and radiological features in pancreatitis

“…29 While Block S, Maier W et al reported pancreatic necrosis in 90% of cases in acute severe pancreatitis and 79% of the cases of mild pancreatitis which was dissimilar to present study. 30 In chronic pancreatitis, pancreatic calcification and visualization of pancreas are seen in 100% of cases. Followed by pancreatic enlargement in 60% of cases and pseudocyst in 30% of cases.…”