There is no obvious cause in up to 30%. For the remainder, alcohol and stones are most common. Fluid collections that do not resolve withi...
There is no obvious cause in up to 30%.
For the remainder, alcohol and stones are most common.
Fluid collections that do not resolve within 4-weeks are pseudocysts.
These complicate about 10% of cases, though half of these resolve without treatment.
Overall mortality is about 5%, but is up to 30% with severe pancreatitis.
Necrosis is the hallmark of severe inflammation and is complicated by infection in up to 70%.
US
• May be normal.
• Generalised/focal gland enlargement with ill-defined margins.
• Reduced reflectivity of the pancreas.
• With or without peripancreatic fluid.
• Check for gallstones.
CT
• May be normal.
• Pancreas enlarged, peripancreatic fat stranding.
• Normal enhancement pattern initially.
• Check for pathology at the left lung base (e.g. atelectasis, pleural effusion, consolidation).
• Areas of reduced enhancement/non-enhancement in the pancreas suggest necrosis.
• Hyperdense areas (50-70 HU) within the gland suggest haemorrhagic inflammation.
• Look for an abscess (i.e. rim-enhancing fluid collection with or without gas bubbles)—forms about 3weeks after the attack in about 5%.
• Pseudocysts are often within/adjacent to the pancreas and managed with large-bore drain (e.g. 24 F) or cyst-gastrostomy.
• Large pseudocysts may cause biliary obstruction.
• Check for vascular complications: splenic artery aneurysm or splenic/portal venous thrombosis (Note: Splenic vein thrombosis causes gastric fundal varices and splenomegaly).
• Other complications include bowel oedema, necrosis and perforation
Acute pancreatitis with pancreatic necrosis and splenic vein thrombus. Axial computed tomography image of the
abdomen following intravenous contrast demonstrating the pancreas to be poorly enhancing (white arrows) with a small filling defect in the splenic vein (red arrow).
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