CT of fluid collections associated with pancreatitis

Surgical management of acute pancreatitis

Acute pancreatitis is a formidable problem that infrequently necessitates surgical intervention. Indications for operation may be divided into four main categories: (1) uncertain diagnosis, (2) deteriorating condition, (3) biliary pancreatitis, and (4) pancreatic abscess. One of the most important contributions concerning acute pancreatitis has been the development of predictive criteria that allow quantitation of the severity of disease and precise comparison of various reported series. During a 2-year period, 222 patients with acute pancreatitis were seen at our institution, and 62 of these patients (28%) underwent operation. Biliary pancreatitis accounted for 63% of our cases. The overall mortality of 24% was directly related to the severity of the pancreatitis. Cholecystectomy, during the same hospital admission, is advised for treatment of biliary pancreatitis.

Splenic complications of a pancreatic pseudocyst

Six patients with pancreatic pseudocyst involving the spleen have been presented. The complications reported included massive hemorrhage into the pseudocyst, sepsis with splenic infarction, and splenic vein thrombosis. The diagnosis of intrasplenic pseudocyst based on clinical findings alone is difficult to arrive at but should be suggested by the presence of a mass in the left upper quadrant. Sonography and computerized axial tomography may be particularly helpful in confirming splenic involvement. Selective celiac arteriography should be performed whenever splenic involvement is suggested in order to confirm the diagnosis and to search for pseudoaneurysm formation. Urgent surgical intervention is usually warranted in view of the high incidence of serious complications and the propensity toward rapid clinical deterioration. Resection of the pseudocyst by splenectomy and distal pancreatectomy is the treatment of choice.

Migrations of fluid of pancreatic origin: ultrasonic and CT study of 28 cases

Efficacious management of migratory collections of pancreatic origin requires precise topographic diagnosis. Such collections can be multiple, atypical and ubiquitous, extending from the mediastinum down to the pelvis, within peritoneal recesses and retroperitoneal spaces, and even within viscera such as the liver, spleen or kidney. Sonography and CT are complementary in the diagnosis and management of such collections.

[Indication and efficiency of computer tomography in general and abdominal surgery]

The efficacy of computed tomography in abdominal surgery must be compared with that of ultrasonography, which is more easily available, less expensive, and entails no radioactive risk. Both methods show high rates of sensitivity, specificity, and accuracy in the detection of parenchymatous lesions, tumors, local complications, tumor recurrences or metastases. Both can be combined with fine-needle biopsy. We think ultrasound scanning is more useful as a primary screening procedure and for follow-up studies, while CT gives a more detailed preoperative diagnosis, including tumor staging.

CT of mediastinal pancreatic fluid collections

Mediastinal extension of an extrapancreatic fluid collection is a rare event. Only 30 cases have been previously reported in the literature. An additional case is presented. In the appropriate clinical setting, plain film and contrast examination of the esophagus and stomach may suggest the diagnosis. While ultrasound may identify supradiaphragmatic extension of fluid, computed tomography is better able to demonstrate the nature and extent of a mediastinal extrapancreatic fluid collection. Preoperatively it is important to recognize that a mediastinal mass represents an extrapancreatic fluid collection because the preferred surgical approach is abdominal.

Pancreatitis-associated fluid collections involving the spleen: sonographic and computed tomographic appearance

The clinical and radiographic features of 2 patients with dissecting pancreatitis-associated fluid collections involving the spleen are described. A typical appearance of left upper quadrant fluid collection lateral to the splenic pulp was observed by ultrasonography (US) or computed body tomography (CBT). Although these findings are nonspecific, a left upper quadrant fluid collection may be characterized definitively by US/CBT-guided needle aspiration.