Findings :
Non enhancement of the tail and distal part of the body of pancreas (white arrow), and normal enhancement of the proximal part (yellow arrow) along with mild peripancreatic fluid collection extends to the left Gerota’s fascia.
· Multiple gall bladder stones ( green arrow )
· Mild ascites
Diagnosis :
Partial necrotizing pancreatitis
Clue for the diagnosis:
The most important finding you have to search in suspected cases of acute pancreatitis, is the presence or absence of necrosis , which presents on enhanced CT as non enhancement of a part ( partial necrotizing) or all ( total necrotizing ) of the pancreas . Necrotic pancreatitis changes the prognosis and mortality rate, as partial necrotizing pancreatitis has a mortality rate up to 70% of cases, whereas total necrotizing pancreatitis has a mortality rate of 100% of cases within 10 days (40% by the 2nd day, 75% by the 5th day and 100% by the 10th day).
Teaching points:
• 70% of acute pancreatitis is due to gallbladder stones.
• The diagnosis is usually made on clinical and laboratory findings.
• An early CT may be misleading concerning the severity of the
pancreatitis, since it can underestimate the presence and amount of necrosis, so
there is no additional value of an early CT (within 72 hours) in patients with
acute pancreatitis.
• There are two types of acute pancreatitis :
- Mild acute pancreatitis ----- 80 % , which is further subdivided
into either edematous ( just swelling of the pancreas ), or exudative ( peripancreatic fluid collections).
- Severe acute pancreatitis ----20 % ( in which there is a pancreatic necrosis, either partial or total ).