EARLY COMPUTERIZED TOMOGRAPHIC SCAN IN MILD PANCREATITIS MAY BE DECEIVING: AN EXPERIENCE OF TERTIARY CARE HOSPITAL

Abstract

Objective: To assess the justification of Computerized Tomographic (CT) scan for the diagnosis of acute
pancreatitis at early stage and its impact on mortality and morbidity of patients
Methodology: It was a retrospective study conducted at Radiology Department Dow University of Health
Sciences from April 2009 to August 2011. Patients were diagnosed as acute pancreatitis both clinically and
radiologically. Severity of acute pancreatitis was clinically assessed by Ranson's criteria and
radiologically by Balthazar CT Grading and CT Severity Index.
Results: Fourteen of the total 131 included patients underwent early CT scan at 4-12 hour after start of
symptoms of abdominal pain and vomiting and were normal radiologically(10.68% out of total 131
patients presented with acute pancreatitis. These patients revisited at 24-36 hours, with severe epigastric
pain and on follow-up CT scan on re-admission, two patients showed intra and peripancreatic collections,
swollen pancreas with peripancreatic fat necrosis without necrotizing pancreatitis (Balthazar Grade-E) and
moderate pancreatitis according to CT Severity Index(four points); Three patients had 30% pancreatic
necrosis with Balthazar grade-E changes and according to CT Severity Index moderate
pancreatitis(2+4=6); Two patients had 30-50% necrosis and rated as Balthazar Grade-E and labeled as
severe necrotizing pancreatitis according to CT Severity Index(4+4=8); while Seven patients showed severe
necrotizing pancreatitis with >50% of pancreatic necrosis according to CT Severity Index(6+4) along with
Balthazar Grade-E pancreatitis(6+4=10). Patients with severity index of 10 had 100% mortality.
Conclusion: Early CT scan has very little role in diagnosing and determining severity of disease or in
predicting prognosis of patients.