Computed Tomography Evaluation of Acute Pancreatitis and Its Complications ??? A Prospective Study at a Tertiary Referral Center

Author(s): Rama Krishna Narra1, Manjeera Boddepalli2, Narasimhachary Munjuwanpalli3, Bhimeswarao Pasupaleti4

Acute pancreatitis (AP) is described as acute inflammation of the pancreas with or
without peripancreatic abnormalities. The present study describes the role of
computed tomography in the evaluation and grading of acute pancreatitis. Acute
pancreatitis is a dynamic disease having biphasic mortality peaks due to two
overlapping phases, which include early and late due to increased obesity, ageing
of population, alcohol abuse, increased gall stone incidence, the worldwide AP
incidence is increasing. Most important causes of AP in developing countries such
as India include increased alcohol consumption. Contrast enhanced computed
tomography plays an important role in diagnosis of the disease and helps in
determining the prognosis of the disease. Modified CT severity index scoring
system is the most commonly used scoring system for assessment of the severity
of the disease.
The present study is a prospective study of patients presenting with signs and
symptoms of acute pancreatitis referred to the Department of Radio Diagnosis at
Katuri medical college. This study comprised of 50 patients with clinical suspicion
/ diagnosis of acute pancreatitis, raised pancreatic biochemical parameters like
serum amylase and serum lipase. Contrast enhanced computed tomography was
performed in these patients, findings reported, and the disease was classified
using modified CT scoring index system (MCTSI).
The mean age of the patients in the present study was 42.3 ± 12.28 years. Most
of the patients presented with abdominal epigastric pain, abdominal distension.
Acute pancreatitis was divided into acute oedematous pancreatitis and necrotising
pancreatitis, the former being common. Complications included, ascites, pleural
effusions, splenic vein thrombosis, portal venous thrombosis, and haemorrhages.
Contrast enhanced CT is useful to differentiate between oedematous and
necrotising types of pancreatitis. The MCTSI helps in better evaluation of pancreatic
necrosis grading. The modified computed tomography score index correlation with
the development of local and systemic complications in acute pancreatitis is well
established. Ideally, conducting contrast enhanced computed tomography (CECT)
after 48 - 72 hours of acute attack, increases the probability of identifying
necrotising pancreatitis. CT in particular has an overall accuracy of about 87 %
and sensitivity and specificity of 100 % in the recognition of pancreatic necrosis.