DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20221179

Estimation of extra-pancreatic necrosis volume and its correlation with the clinical outcome in acute pancreatitis

Manish Thapa, Pankaj Sharma, Birma Ram

Abstract


Background: The aim of study was to measure extra-pancreatic necrosis volume in acute pancreatitis and associate with the clinical outcome and to determine the threshold volume of extra-pancreatic necrosis that predicts severity of acute pancreatitis.

Methods: Hospital based observational study was carried out in the department of radiodiagnosis, Armed forces medical college, Pune, Maharashtra. All cases referred for CT scan in suspected cases of acute pancreatitis (by clinical and/or biochemical parameters) as a part of institutional protocol were included in the study. Multiplanar reconstruction with volumetric analysis was done for measuring the extra-pancreatic necrosis volume (EPNV) using inherent CT scanner volume assessing software.

Results: Out of total 41 patients studied, more than one cause was identified in 9 patients. The most common cause of acute pancreatitis was alcohol use 32 (64%), followed by gallstone and diabetes mellitus (8% each). There was a positive correlation between EPNV and duration of hospitalization which was statistically significant with Spearman's correlation coefficient of 0.579 and p<0.001.

Conclusions: Our study showed highly significant correlation between the EPNV and the prediction of end organ failure, systemic infection, duration of hospital stay and need for intervention. Statistically patient presenting with EPNV of more than 100 ml was closely associated with end organ failure; hence EPNV may be used as a useful scoring system. This study has highlighted the convenient and easier technique of predicting clinical outcome in patient by simply assessing the severity of acute pancreatitis by measuring EPNV.

 


Keywords


Acute pancreatitis, Extra-pancreatic necrotic volume, Computed tomography, Computed tomography severity index, Organ failure

Full Text:

PDF

References


Delrue LJ, De Waele JJ, Duyck PO. Acute pancreatitis: radiologic scores in predicting severity and outcome. Abdominal imaging. 2010;35(3):349-61.

Bradley EL. A clinically based classification system for acute pancreatitis: summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Archives of surgery. 1993;128(5):586-90.

Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. American Journal of Roentgenology. 2004;183(5):1261-5.

Haaga JR. CT and MRI of the whole body. 5th edn. Philadelphia, PA: Mosby.

Meyrignac O, Lagarde S, Bournet B, Mokrane FZ, Buscail L, Rousseau H et al. Acute pancreatitis: extrapancreatic necrosis volume as early predictor of severity. Radiology. 2015;276(1):119-28.

Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223(3):603-13.

Koutroumpakis E, Furlan A. Investigating the predictive role of computed tomography in patients with acute pancreatitis: let’s not give up. Annals of gastroenterology. 2015;28(3):299.

Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. The American journal of gastroenterology. 2006;101(10):2379.

Banday IA, Gattoo I, Khan AM, Javeed J, Gupta G, Latief M. Modified Computed Tomography Severity Index for Evaluation of Acute Pancreatitis and its Correlation with Clinical Outcome: A Tertiary Care Hospital Based Observational Study. Journal of clinical and diagnostic research: JCDR. 2015;9(8):TC01-5.

Sharma V, Rana SS, Sharma RK, Kang M, Gupta R, Bhasin DK. A study of radiological scoring system evaluating extrapancreatic inflammation with conventional radiological and clinical scores in predicting outcomes in acute pancreatitis. Annals of gastroenterology: quarterly publication of the Hellenic Society of Gastroenterology. 2015;28(3):399.

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.

Bollen TL, Singh VK, Maurer R, Repas K, Van Es HW, Banks PA et al. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. The American journal of gastroenterology. 2012;107(4):612-9.

Jáuregui-Arrieta LK, Alvarez-López F, Cobián-Machuca H, Solís-Ugalde J, Torres-Mendoza BM, Troyo-Sanromán R. Effectiveness of the modify tomographic severity index in patients with severe acute pancreatitis. Revista de gastroenterologia de Mexico. 2008;73(3):144-8.

Dugernier T, Laterre PF, Reynaert M, Deby-Dupont G. Compartmentalization of the protease-antiprotease balance in early severe acute pancreatitis. Pancreas. 2005;31(2):168-73.

Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR. American journal of roentgenology. 1998;170(4):969-75.

Chatzicostas C, Roussomoustakaki M, Vardas E, Romanos J, Kouroumalis EA. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II and III scoring systems in predicting acute pancreatitis outcome. Journal of clinical gastroenterology. 2003;36(3):253-60.

Mole DJ, McClymont KL, Lau S, Mills R, Stamp-Vincent C, Garden OJ et al. Discrepancy between the extent of pancreatic necrosis and multiple organ failure score in severe acute pancreatitis. World journal of surgery. 2009;33(11):2427.

Appelros S, Borgström A. Incidence, aetiology and mortality rate of acute pancreatitis over 10 years in a defined urban population in Sweden. British journal of surgery. 1999;86(4):465-70.