Pancreas rule 6 : Acute pancreatitis

Acute pancreatitis  

¨ Infection and trauma especially in infants , in addition to post ERCP infection

¨There are two types of acute pancreatitis , edematous type,95%, ch.ch.by fluid collection and high incidence of resolution , while the second one is hemorrhagic type,5%, with high incidence of morbidity and

¨mortality

¨CT findings

¨Diffuse swelling of pancreatic parenchyma which is unreliable sign

¨Dirty peri pancreatic fat which is  unreliable sign

¨  

Peri-pancreatic fluid collection most important sign  in the lesser sac and anterior para-renal space which could be free or loculated ---Pseudo cyst

¨Decreased pancreatic density --reliable sign

¨Fluid collection around pancreas is diagnostic for acute pancreatitis

¨Left sided pleural effusion

¨Necrotizing pancreatitis ch.ch.by decreased density due to presence of air  and fluid collection

¨Increased amylase enzyme

¨Pancreatic fluid may cause irritation of the wall of stomach , duodenum or colon

¨Complications of pancreatitis

¨Hemorrhagic pancreatitis due to destruction of vessels by inflammation--least common--- appears as hyper dense  acute blood in 5% for surgical emergency

¨Vascular thrombosis due to inflammation , the most common vein to be thrombosed , is superior mesenteric vein , or forming pseudo aneurysm

¨Pancreatic abscess, less common

¨Pancreatic pseudo-cyst, most common,
to differentiate between it and abscess , look for air inside , if it is present , it will be an abscess
Do not depend upon thickness of the wall in differentiation between abscess and pseudocyst 

¨The summary of all the above is that to diagnose acute pancreatitis you should find fluid around pancreas in free or encysted form. The free form can extends to lesser sac , anterior para-renal spaces on both sides mainly the left one finally may extends to Peri-renal spaces. Also , this fluid collection may cause irritation of walls of stomach , duodenum or colon

¨To differentiate between localized acute pancreatitis(which is rare) and focal mass look for contour deformity , which is seen with the latter and not with the former

¨Pancreatic phlegmon is a mass of inflammatory tissue that may resolve or liquify to form pseudo cyst