Management Acute Pancreatitis

Acute Mild Pancreatitis

CT Scan Picture shows

1. Enlarged gland

2. Patchy attenuation in the peripancreatic fat

3. Thickening of fascial planes

4. Cuff of fluid around the peripancreatic vessels

5. Pancreas shows uniform enhancement

Severe Acute Pancreatitis

Pancreatic Necrosis

1. Areas of non enhancement in the pancreatic tissue

Areas of non enhancement are divided into less than 30%, 30-50% and more than 50%

2. Areas of gas bubbles in non enhanced areas suggest infected pancreatic necrosis

Fistula with the GI tract

Pancreatic Abscess

Non categorised fluid collections

Ares of gas bubbles

Pseudocyst

Fluid collection that persists beyond 4 week

Involvement of surrounding arteries and veins with pseudoaneurysm

Involvement Erosion of GI tract

CTSI SCoring System for Severity of Pancreatitis (Balthazar)

CT finding Score

Normal 0

Focal or diffuse Enlargement 1

Peripancreatic inflamatory changes 2

Single fluid collection 3

Two or more fluid collection or abscess 4

Necrosis

None 0

less than 30% 2

30-50% 4

More than 50% 6

Surgery in Pancreatitis

Definitive indications for operative treatment and necrosectomy are the following:

• Failure of nonoperative management with at least 48 hours of maximal ICU support

• Infected necrosis

• Extravisceral air

• Hemorrhage uncontrolled by interventional techniques

• Colonic complications

Types of Surgical Options Available

• Closed packing (High Rate of Reoperation and abscess)

• Open drainage (High Rate of Pancreatic Fistula)

• Closed high-volume lavage of the lesser sac

• Repeated, planned necrosectomy with abdominal wall closure