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

Abstract

The purpose of this study was to describe CT findings of colonic involvement in acute nonnecrotizing pancreatitis and to analyze the correlation between colonic wall thickening at CT and the clinical course of these patients. The CT examinations of 19 consecutive patients with acute non-necrotizing pancreatitis who were not treated with antibiotics initially were analyzed retrospectively. The severity of acute pancreatitis was categorized according to the CT severity index (CTSI) and the presence of colonic wall thickening at the initial CT was compared with the clinical course of all patients. Seven of 11 patients with a CTSI of 4 showed a colonic wall thickening, whereas the remaining patients with a CTSI of 4 (n=4), CTSI of 3 (n=5), and CTSI of 2 (n=3) showed no colonic abnormalities at CT. Patients with colonic wall thickening presented more often with fever, showed higher levels of infectious parameters, needed more often antibiotic therapy, and had more requests for additional CT examinations and CT-guided fluid aspirations as well as a longer duration of hospital stay as compared with patients without colonic wall involvement, even if the latter presented with the same CTSI initially. It is well known that translocation of the colonic flora may significantly influence the clinical course of patients with acute pancreatitis, and our results indicate that patients with acute pancreatitis who present with colonic wall thickening at CT have an increased risk for a complicated clinical course regarding systemic infection.

Evaluation of extrapancreatic inflammation on abdominal computed tomography as an early predictor of organ failure in acute pancreatitis as defined by the revised Atlanta classification

“…Furthermore, EPIC scores can predict pancreatic pseudocysts in the early phase of severe AP. [28] Conversely, distinct from our findings, Mortele and colleagues [29] did not find a significant correlation between the prevalence of renal/perirenal involvement in complications and severity of pancreatitis.…”

The Atlanta Classification of acute pancreatitis revisited

“…The authors of 45 articles used the absence and presence of pancreatic necrosis broadly synonymously with mild and severe acute pancreatitis respectively47, 51, 52. Some reports, however, pointed out that patients with the morphological diagnosis of interstitial pancreatitis may develop clinically severe disease44, 53, 54.…”

“…In 64 articles, a definition was given for an ‘acute fluid collection’. The following terms were used to describe acute fluid collections: ‘(peri)pancreatic fluid collections’75–77, ‘peripancreatic effusions’78, ‘extrapancreatic fluid collections’61, 79, 80, ‘immature pseudocyst’81, 82 and ‘exudates’54. (Peri)pancreatic fluid collection was also used as an overall descriptive term for all types of collection related to acute pancreatitis83–85.…”

Acute Pancreatitis-A Prospective study of Estimation of Prognosis with MCTSI versus CTSI

“…This CT Severity Index was found to have a better prognostic accuracy than the earlier score but it, too, was found to have some limitations. First, the score obtained with the index did not incorporate the presence of organ failure [14] extra pancreatic parenchymal complications [15] or peripancreatic vascular complications [16] and their correlation with the final outcome. Secondly, as documented in some studies, inter-observer agreement for scoring the CT scans using the CT Severity Index was only moderate, with a reported agreement of approximately 75% [17,18].…”