ACUTE PANCREATITIS AND ITS COMPLICATIONS: ROLE OF CONTRAST ENHANCED COMPUTED TOMOGRAPHY

Dr. Dharam Dev, Dr. Hitesh Kumar* and Dr. Esha Singh

ABSTRACT

Background: Serum amylase and lipase levels are traditionally used in the diagnosis of acute pancreatitis. However clinical course and complications of acute pancreatitis cannot be determined by enzymes levels. Contrast enhanced computed tomography is vital in assessing the course and complications of acute pancreatitis. Methods: In this study, total 37 patients were included who presented with clinical suspicion of acute pancreatitis. These patients were evaluated clinically, biochemical analysis was done and then CECT was done in all cases after 72 hours. CECT findings were evaluated in all the patients. Patients were classified into AIEP and ANP groups. Patients in both the groups were followed up for complications at two months interval. Results: 75.7% of the study population had acute interstitial edematous pancreatitis(AIEP) and 24.3% had acute necrotizing pancreatitis(ANP).On follow up, complications were significantly more in ANP group as compared to AIEP group (22.2% vs 17.8%).). 29.8% of patients had less than three fold rise in serum lipase levels at presentation despite signs of acute pancreatitis on CECT. Conclusion: Contrast enhanced computed tomography (CECT) is standard imaging modality for the evaluation of acute pancreatitis and its complications. Using enzyme assay of serum amylase and lipase, clinicians can establish the diagnosis but cannot evaluate for pancreatic necrosis and its vascular complications. Moreover significant subset of patients can have less than three fold rise in serum lipase and amylase level.

Keywords: Acute pancreatitis; complications; contrast enhanced computed tomography.