Diagnosis of pancreatic duct disruption in acute pancreatitis

Objective. To study signs of pancreatic duct disruption in the early phase of necrotizing pancreatitis.

Material and methods. Contrast-enhanced CT was performed in 227 patients, in 67 patients – on the 2nd and 3rd days from the disease onset. Damage of the pancreas was estimated according to the configuration of necrosis: the depth of necrosis in the sagittal plane (transverse necrosis) and the mutual location of necrosis and healthy parenchyma. At the 1st type of configuration it was more distal than necrosis, at the 2nd type – absent. Peripancreatitis was assessed according to Ishikawa criteria, we studied alpha-amylase activity in fluid collections. The effect of the depth of necrosis and its volume (the Balthazar criterion) on the severity of peripancreatitis was compared.

Results. Necrotizing pancreatitis was detected in 200 patients: in 132 patients – type 1 (necrosis of the head, isthmus, body, initial part of the tail), in 30 – type 2 (necrosis of the tail), in 38 – necrotizing pancreatitis with localization of acute necrotic collections only in the retroperitoneal tissue. Advanced peripancreatitis was revealed in 80% of patients at early term and was present in 19 of 26 patients with early organ failure. It was more severe in type 1 in comparison with type 2 by Ishikawa criteria (5.28 ± 0.25 vs 4.27 ± 0.43, p < 0.05), by accumulation volume (278 and 166 cc, p < 0.05), by presence of high (over 1000 units/L) alpha-amylase activity 1in fluid. The depth of necrosis greater than the volume determined the degree of peripancreatitis in the first and second CT studies (data from multivariate variance and regression analyses).

Conclusion. Deep transverse necrosis in patients with type 1 configuration and high alpha-amylase activity in fluid collections are early signs of disconnected pancreatic duct syndrome. They determine the severity of peripancreatitis and systemic complications. Computed tomography allows you to diagnose this in the first 2–3 days from the onset of the disease.

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