TO STUDY THE SIGNIFICANCE OF COMPUTED TOMOGRAPHIC EVALUATION OF ACUTE PANCREATITIS: SINGLE CENTRE STUDY.

Abstract

Background: Acute pancreatitis is a common disease with high rate of morbidity and mortality. Computed tomography is the gold standard technique not only for its global picture of the pathology and for the non-invasive method of evaluating the morphology of pancreas and peripancreatic regions in an acute situation.

Aim- to study the significance of computed tomographic evaluation of acute pancreatitis: single centre study.

Methodology: A prospective study comprise of 50 patients, done in department of radiodiagnosis of Peoples College of Medical Sciences and Research Centre, Bhopal, from January 2022 to January 2034 on clinical suspicion/diagnosis of acute pancreatitis, altered biochemical parameters (serum amylase, serum lipase) in favour of acute pancreatitis, Ultrasonography suggestive of acute pancreatitis and known case of chronic pancreatitis with features of acute symptoms referred to Department of Radio-diagnosis, Medical College and Research Hospital for computed tomography scan of abdomen and pelvis using Toshiba Asteion spiral Computed Tomography scan. Plain and post-contrast series of the abdomen and pelvis were taken.

Results: In this prospective study of 50 patients, 40 were male and 10 were female patients. The mean age of patients in the study was 36.50 + 12.45 years. The maximum patients were in the age group of 25 to 35 years (40%). The next group with maximum patients was in the 36 to 45 years group (20%). The minimum age of patients was 17 years and maximum age was 62 years. Among these edematous pancreatitis was in 20% patients and pancreatic necrosis was in 24% patients. Other features like diffuse/focal pancreatic enlargement in (75%), peri-pancreatic fat stranding in (64%) and peri-pancreatic fluid collection in (40%). Among this alcohol was the most common cause of AP (84%). The accuracy and sensitivity of serum amylase and serum lipase in diagnosing AP were 40% and 64% respectively with CT showing 100% accuracy and sensitivity. Modified CT severity index was classified as mild (2 and 4), moderate (6) and severe (8 and 10) of which majority were mild (66%), moderate (22%) and severe (12%).

Conclusion: Computed tomography is a sensitive, non-invasive imaging in early diagnosis and staging of severity of acute pancreatitis which help in prediction of prognosis of the disease. It helps to differentiate between edematous and necrotizing pancreatitis as serum lipase and amylase levels do not help to differentiate the type of AP. Modified CT severity index helps in evaluating the percentage pancreatic necrosis and to predict the possibility of developing local and systemic complications and necessity of tertiary care