Hämorrhagisch-nekrotisierende Pankreatitis und bildgebende Verfahren

Abstract

Ultrasound and computed tomography have been used routinely over the last five years in the diagnosis of acute pancreatitis. This has made classification as to degrees of severity easier. In addition to the direct imaging of destruction of pancreatic parenchyma, these imaging methods also (preoperatively) make an exact assessment of the extension of peripancreatic necrosis and necrosis paths possible, as well as the presence of any gallstone disease or pancreatic abscess. Under the influence of these imaging procedures the indications for operation and the extent of surgical intervention has become more limited. High-risk "early operation" has been drastically reduced in number and is indicated only in very severe disease with organ complications. The "delayed operation" in the postacute stage of disease is largely restricted to local septic complications. Here excision of necrotic tissue and drainage is now largely preferred to resection, previously practised more frequently. Extensive necrotising processes with only minor clinical symptoms have now been observed as a result of early employment of ultrasound and computed tomography. The successful conservative treatment of these uncomplicated disease processes has contributed to an overall reduction in the mortality of postacute pancreatitis.