Is an early ultrasound scan of value in acute pancreatitis?

Abstract

Grey scale ultrasound scanning has been performed within 1 week of admission in 114 patients with acute pancreatitis in order to establish its reliability in detecting gallstones and to document early pancreatic changes. When the gallbladder was identified (69.4 per cent of patients), grey scale ultrasound was 96.1 per cent accurate in predicting the presence of gallstones. Of 85 patients (74.5 per cent), in whom adequate pancreatic imaging was achieved on the initial scan, 35 were reported within normal limits, 28 had generalized pancreatic swelling and 22 a localized pancreatic mass of cystic collection. These ultrasound findings did not correlate significantly with the objective assessment of severity of disease. However, all 9 patients (8.1 per cent) who developed a pseudocyst were in the group shown to have early localized pancreatic swelling. Grey scale ultrasound is a useful method of detecting gallstones in patients with acute pancreatitis, thus permitting early accurate biliary surgery. However, in almost one-third of our patients ultrasound failed to outline the gallbladder on the initial scan. While ultrasound scanning of the pancreas will detect the formation of pseudocysts and accurately chart their subsequent progress, we doubt whether an early scan is required to achieve this purpose. Although generalized pancreatic swelling is frequently reported, this finding was of no major clinical importance and did not relate to the severity of disease.

Laparoscopic management of acute biliary pancreatitis

“…The gallbladder can be assessed for stones and the CBD can be evaluated for size and the presence of stones. Unfortunately, the value of US is often limited by the presence of intestinal air obscuring biliary structures and the pancreas in almost one-third of patients with acute pancreatitis [12]. Currently the best method to stage the acute pancreatitis is CT.…”

Management of severe acute pancreatitis

“…This is because of the high incidence of incomplete examinations due to overlying bowel gas; the gland is poorly visualized in 25-30 per cent of instances 30 . In a study comparing transcutaneous ultrasonography and CT with Ranson's criteria and operative findings, initial ultrasonography was found to be an unsatisfactory investigation for the detection of pancreatic necrosis 31 .…”

“…In a study comparing transcutaneous ultrasonography and CT with Ranson's criteria and operative findings, initial ultrasonography was found to be an unsatisfactory investigation for the detection of pancreatic necrosis 31 . However, ultrasonography is useful in determining the aetiology of pancreatitis, by demonstrating gallstones or common bile duct dilatation, and detecting free peritoneal fluid 30 . It is recommended as the initial investigation in all patients with acute pancreatitis 32 , especially if gallstones are suspected 33 .…”

Radionuclide Biliary Scanning in the Diagnosis of Gallstone Pancreatitis

“…There is little justification in performing a diagnostic laparo tomy for acute pancreatitis and the risks of endoscopic retrograde cholangiopancreatography (ERCP) in the pres ence of pancreatitis are unknown. Paralytic ileus and deranged liver function account for the high rate of false positive diagnoses associated with oral and intravenous cholecystography [5,6] while anaphylactic reactions are not uncommon with the latter technique [16], Ultraso nography is independent of hepatic function, but is oper ator-dependent and in a recently published series, 30% of GBs could not be visualized in the presence of pancreati tis [17], Analysis of clinical and biochemical indices have been used to predict the presence of gallstones with accu racies of over 80% [18,19] but such methods are unlikely to be adopted as a basis for surgery in preference to imag ing techniques.…”