[Acute pancreatitis: prognostic value of early x-ray computed tomography coupled with Ranson's criteria and its role in surveillance of the course]

Abstract

Fifty nine patients suffering from a first attack of acute pancreatitis were investigated during the first ten days of illness with computerized tomography (CT scan) and biological signs of Ranson. The prognostic value of the combination of these two classes of signs was evaluated. The grading of initial CT scan findings was accorded to the Ranson and Balthazar classification. In addition, the authors evaluated the presence and extent of necrosis and studied phlegmonous extrapancreatic spread. A high risk group of patients was determined: grade C, D, E, with at least three prognostic signs. Twelve of these high risk patients with grade D and E had a glandular necrosis as detected on initial contrast enhanced CT scan. This was an important prognostic value sign (sensibility 100 percent; specificity 92 percent) as all morbidity was 100 percent compared with 8.5 percent among the 47 other patients who did not exhibit this CT sign; mortality was 25 percent compared with 0 percent among the other patients. Phlegmonous extrapancreatic spread in three or more areas also influenced the prognostic but to a lesser extent (sensibility 100 percent; specificity 62 percent). Forty-four patients among the fifty-nine had a morphologic follow-up of the course of lesions by repeated CT scan. Local complications occurred only in patients at high risk: 9 pancreatic abscesses (20.4 percent) and 6 pseudocysts (15 percent). One-third of the twenty-one grade D and E patients had spontaneous resorption of the phlegmonous extrapancreatic areas.(ABSTRACT TRUNCATED AT 250 WORDS)