Isolated Peripancreatic Necrosis in Acute Pancreatitis Is Infrequent and Leads to Severe Clinical Course Only When Extensive: A Prospective Study From a US Tertiary Center

J Clin Gastroenterol. 2016 Aug;50(7):589-95. doi: 10.1097/MCG.0000000000000482.

Abstract

Goals: To explore the diagnostic challenges, management, and clinical outcomes of patients with isolated peripancreatic necrosis (PPN), with emphasis on the extent of involvement, and compare them to pancreatic necrosis (PN).

Background: PPN, a relatively new term, has been included as a separate entity in the Revised Atlanta Classification.

Study: Clinical data of recruited acute pancreatitis patients were recorded prospectively. Contrast-enhanced computed tomographic scans were reviewed by expert radiologists blinded to clinical outcomes.

Results: In total, 271 of the 400 acute pancreatitis patients underwent contrast-enhanced computed tomography, of which 29 (11%) had PPN (14: limited; 15: extensive) and 124 (46%) PN (40: <30%, 16: 30% to 50%, 68: >50% of parenchyma). Patients with PPN were similar to PN in age (56 y), gender (55% male), and body mass index (29 kg/m(2)). Nutritional support was provided in 18 (62%) patients with PPN and 97 (78%) with PN (P=0.12). Drainage/debridement was required in 2 patients (7%) with PPN and 64 (53%) with parenchymal necrosis (P<0.001). Persistent organ failure rates did not differ significantly (34% vs. 51%, P=0.17), but hospital stay was shorter in patients with PPN (15 vs. 20 d, P=0.05). Limited PPN required no intervention and had similar persistent organ failure rates and hospitalization length with interstitial pancreatitis (both P≥0.12). Extensive PPN mainly developed in patients with persistent organ failure (60%) and rarely required drainage (2/15).

Conclusions: PPN prevalence was lower than PN with a ratio of 1:4. PPN rarely required intervention. Utilizing the extent of involvement has the potential to classify PPN and PN with escalating clinical significance and guide management.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Multiple Organ Failure / epidemiology
  • Nutritional Support
  • Pancreas / diagnostic imaging
  • Pancreas / physiopathology*
  • Pancreatitis, Acute Necrotizing / diagnostic imaging
  • Pancreatitis, Acute Necrotizing / epidemiology*
  • Pancreatitis, Acute Necrotizing / physiopathology
  • Prospective Studies
  • Retrospective Studies
  • Severity of Illness Index
  • Tertiary Care Centers
  • Tomography, X-Ray Computed*
  • United States