Brief Article
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World J Gastroenterol. Sep 14, 2010; 16(34): 4291-4296
Published online Sep 14, 2010. doi: 10.3748/wjg.v16.i34.4291
Peripancreatic collections in acute pancreatitis: Correlation between computerized tomography and operative findings
Santhi Swaroop Vege, Joel G Fletcher, Rupjyoti Talukdar, Michael G Sarr
Santhi Swaroop Vege, Rupjyoti Talukdar, Miles and Shirley Fiterman Center for Digestive Diseases, Rochester, MN 55905, United States
Joel G Fletcher, Department of Radiology, Mayo Clinic, Rochester, MN 55905, United States
Michael G Sarr, Department of Surgery, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Vege SS conceptualized, designed and supervised the study; Fletcher JG evaluated the CT scans; Talukdar R performed the statistical analysis and prepared the draft manuscript; Sarr MG analyzed the surgical notes and classified the peripancreatic fluid collections; all authors participated in the analysis and writing of the manuscript.
Correspondence to: Santhi Swaroop Vege, Professor, Miles and Shirley Fiterman Center for Digestive Diseases, 200 First Street SW, Rochester, MN 55905, United States.
Telephone: +1-507-2842478  Fax: +1-507-2660350
Received: December 2, 2009
Revised: May 15, 2010
Accepted: May 22, 2010
Published online: September 14, 2010

AIM: To evaluate the ability of contrast-enhanced computerized tomography (CECT) to characterize the nature of peripancreatic collections.

METHODS: Twenty five patients with peripancreatic collections on CECT and who underwent operative intervention for severe acute pancreatitis were retrospectively studied. The collections were classified into (1) necrosis without frank pus; (2) necrosis with pus; and (3) fluid without necrosis. A blinded radiologist assessed the preoperative CTs of each patient for necrosis and peripancreatic fluid collections. Peripancreatic collections were described in terms of volume, location, number, heterogeneity, fluid attenuation, wall perceptibility, wall enhancement, presence of extraluminal gas, and vascular compromise.

RESULTS: Fifty-four collections were identified at operation, of which 45 (83%) were identified on CECT. Of these, 25/26 (96%) had necrosis without pus, 16/19 (84%) had necrosis with pus, and 4/9 (44%) had fluid without necrosis. Among the study characteristics, fluid heterogeneity was seen in a greater proportion of collections in the group with necrosis and pus, compared to the other two groups (94% vs 48% and 25%, P = 0.002 and 0.003, respectively). Among the wall characteristics, irregularity was seen in a greater proportion of collections in the groups with necrosis with and without pus, when compared to the group with fluid without necrosis (88% and 71% vs 25%, P = 0.06 and P < 0.01, respectively). The combination of heterogeneity and presence of extraluminal gas had a specificity and positive likelihood ratio of 92% and 5.9, respectively, in detecting pus.

CONCLUSION: Most of the peripancreatic collections seen on CECT in patients with severe acute pancreatitis who require operative intervention contain necrotic tissue. CECT has a somewhat limited role in differentiating the different types of collections.

Keywords: Contrast-enhanced computerized tomography, Correlation, Pancreatic necrosis, Pancreatitis, Peripancreatic fluid collection, Surgery