Accuracy of early CT findings for predicting disease course in patients with acute pancreatitis

Abstract Purpose Intraabdominal hypertension (IAH) in acute pancreatitis (AP) may reduce tissue perfusion and impair organ function and has been shown to portend poor prognosis. We investigated the computed tomography (CT) findings in patients with AP with IAH. Methods This retrospective study comprised of consecutive patients with AP from June 2016 to June 2018 in whom intraabdominal pressure (IAP) was measured. The patients who underwent a contrast-enhanced CT within 7 days of IAP measurement were included. Using a cutoff of 12 mm Hg for IAP, the patients were divided into IAH and non-IAH groups. Measures of severity and clinical outcome were evaluated. CT parameters were compared between the groups. Results The IAH group comprised of 41 patients, while there were 20 patients in the non-IAH group. The IAH group was characterized by severe disease, increased incidence of organ failure, increased requirement for drainage and surgery, prolonged hospital and intensive care unit stay. The mortality was not significantly different between the two groups. On univariate analysis, the CT features that were found to be significantly different between the two groups were the presence of collection (p = 0.036), the maximum dimension of collection (p = 0.004), volume of collection (p = 0.019), biliary dilatation (p = 0.011), and the presence of moderate-to-severe pleural effusion (p = 0.009). On multivariate analysis, all these parameters except biliary dilatation were found to be statistically significant. Conclusion CT findings in patients with AP may suggest IAH. This can be used as an additional marker for severity of AP.

Download Full-text

Colonic involvement in non-necrotizing acute pancreatitis: correlation of CT findings with the clinical course of affected patients

European Radiology ◽

10.1007/s00330-002-1517-9 ◽

2003 ◽

Vol 13 (4) ◽

pp. 897-902 ◽

Cited By ~ 12

Author(s):

W. Wiesner ◽

U. Studler ◽

T. Kocher ◽

L. Degen ◽

C. Buitrago-Tellez ◽

...

Keyword(s):

Acute Pancreatitis ◽

Clinical Course ◽

Colonic Involvement ◽

Ct Findings

Download Full-text

Severe acute pancreatitis- it's diagnosis and management- A study of 20 cases

Community Based Medical Journal ◽

10.3329/cbmj.v8i2.55768 ◽

2019 ◽

Vol 8 (2) ◽

pp. 17-29

Author(s):

Mohammad Monir Hossain ◽

S M Shakwat Hossain ◽

Delowar Hossain

Keyword(s):

Acute Pancreatitis ◽

Conservative Treatment ◽

Severe Acute Pancreatitis ◽

Pancreatic Necrosis ◽

Military Hospital ◽

Fatty Tissue ◽

Ct Findings ◽

Contrast Enhanced Ct ◽

Management Protocol ◽

Life Threatening

Background: Severe acute pancreatitis is defined as pancreatitis in which there is persistent organ failure that does not resolve within 48 hours. Severe acute Pancreatitis is characterized by pancreatic necrosis, a severe systemic inflammatory response and often multiorgan failure. Severe acute pancreatitis is a serious and life threatening disease. Mortality varies from 20 to 50 percent. Objective: The objectives of this study are to develop our knowledge about presentation and diagnosis of severe acute pancreatitis, and to develop a standard management protocol to rescue that patient suffering from severe acute pancreatitis. Methods: This observational study was carried out in Combined Military Hospital (CMH) Dhaka, during the period of August 2014 - Feb 2015. A total 20 patients of severe acute pancreatitis were studied prospectively, evaluated and managed. Results: In this study, out of 20 patients 12(60%) male and 08(40%) female. Male: Female = 3:2. The youngest patient of this series was 03 years and oldest was of 55 years. First categorization of severity of acute pancreatitis was done on the basis of Ranson score. Those patients whose score is 3 or more are categorized as severe. After categorization subsequent management was planned on the basis of laboratory and CT findings. Out of 20 patients all have raised WBC, serum Calcium level decrease in 16 patients, LDH raised in 16 patients, PaO2 decrease in 14 patients, Base deficitincreased in 12 patients, and blood urea nitrate raised in 14 patients. Contrast enhanced CT scan done in all patients and 12 patients were found with reduced enhancement in pancreas, peripancreatic edema and stranding of fatty tissue and remaining 8 patients have fluid collected in peri- and retro pancreatic space. Total 12 patients were given conservative treatment. Remaining 8 patients were operated whose CT findings were reduced enhancement in pancreas and these patients were suspected for infective pancreatic necrosis. In this study 3 patients were expired. Out of these three patients, 2 patients underwent operative intervention and 1 patient was given conservative treatment. Conclusion: Severe acute pancreatitis is a life threatening condition. Its serious regional and systemic involvement causes multiple organ or system failure. Early diagnosis and effective treatment can significantly reduce the mortality and morbidity. CBMJ 2019 July: Vol. 08 No. 02 P: 17-29

Download Full-text

Acute pancreatitis: clinical vs. CT findings

American Journal of Roentgenology ◽

10.2214/ajr.139.2.263 ◽

1982 ◽

Vol 139 (2) ◽

pp. 263-269 ◽

Cited By ~ 61

Author(s):

MC Hill ◽

J Barkin ◽

MB Isikoff ◽

W Silverstein ◽

M Kalser

Keyword(s):

Acute Pancreatitis ◽

Ct Findings

Download Full-text

Disease Course Differences in Acute Pancreatitis Based on Etiology Using the Pancreatitis Activity Scoring System

Pancreas ◽

10.1097/mpa.0000000000001091 ◽

2018 ◽

Vol 47 (7) ◽

pp. e40-e41 ◽

Cited By ~ 1

Author(s):

Daniel Lew ◽

Bechien U. Wu ◽

Stephen J. Pandol ◽

Catherine A. Sugar ◽

Damla Senturk ◽

...

Keyword(s):

Acute Pancreatitis ◽

Scoring System ◽

Disease Course

Download Full-text

Diagnostic accuracy of ultrasound in common acute abdominal conditions

International Surgery Journal ◽

10.18203/2349-2902.isj20195413 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4460

Author(s):

Shashank Deshmukh ◽

A. Manmadha Kishan

Keyword(s):

Acute Pancreatitis ◽

Acute Appendicitis ◽

Intestinal Obstruction ◽

Diagnostic Accuracy ◽

Acute Intestinal Obstruction ◽

Ct Findings ◽

Perforation Peritonitis ◽

Good For ◽

Operative Findings ◽

Acute Perforation

Background: Ultrasound evaluation is cheap, easily available, even at rural level, and can predict need for surgical intervention in majority of conditions. It involves no exposure to radiation, can diagnose easily, can be repeated any number of times for follow up. Disadvantages are that it is user dependent and distended bowel containing air prevents satisfactory evaluation of abdomen. The objective was to study diagnostic accuracy of ultrasound in common acute abdominal conditions.Methods: All patients presenting to the emergency Department of General Surgery, Narayana general hospital, Nellore with abdominal pain of acute onset and who were diagnosed to be suffering from acute appendicitis, acute perforation peritonitis, acute intestinal obstruction, acute pancreatitis, acute calculous cholecystitis were included in the present study.Results: Diagnostic accuracy of USG for acute appendicitis was little bit low with sensitivity of 71.8% and specificity of 59.1% for operative findings and similar for CT findings. For acute perforation peritonitis it was still very low with sensitivity of 42.9% and specificity of 66.7% for operative findings and similar for CT findings. It was very good for acute intestinal obstruction with sensitivity of 90.9% and specificity of 83.3%, but here it was low compared to CT findings. It was also pretty good for diagnosing acute calculus cholecystitis in comparison with operative as well as CT findings.Conclusions: USG can be used as a diagnostic tool for diagnosis of acute intestinal obstruction and acute calculus cholecystitis but doubtful role in the diagnosis of acute appendicitis and acute perforation peritonitis and acute pancreatitis.

Download Full-text