Outcome of Acute Pancreatic and Peripancreatic Collections Occurring in Patients With Acute Pancreatitis. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Manrai, Manish; Kochhar, Rakesh; Gupta, Vikas; Yadav, Thakur Deen; Dhaka, Narendra; Kalra, Naveen; Sinha, Saroj K.; Khandelwal, Niranjan
• Is Part Of: Annals of surgery. Volume 267:Issue 2(2018:Feb.)
• Publication Date: 2018-02
• Subjects: acute collections -- acute necrotic collections -- acute pancreatitis -- intervention -- revised Atlanta classification -- walled-off necrosis; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002065
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To study the outcome of acute collections occurring in patients with acute pancreatitis Background: There are limited data on natural history of acute collections arising after acute pancreatitis (AP). Methods: Consecutive patients of AP admitted between July 2011 and December 2012 were evaluated by imaging for development of acute collections as defined by revised Atlanta classification. Imaging was repeated at 1 and 3 months. Spontaneous resolution, evolution, and need for intervention were assessed. Results: Of the 189 patients, 151 patients (79.9%) had acute collections with severe disease and delayed hospitalization being predictors of acute collections. Thirty-six patients had acute interstitial edematous pancreatitis, 8 of whom developed acute peripancreatic fluid collections, of which 1 evolved into pseudocyst. Among the 153 patients with acute necrotizing pancreatitis, 143 (93.4%) developed acute necrotic collection (ANC). Twenty-three of 143 ANC patients died, 21 had resolved collections, whereas 84 developed walled-off necrosis (WON), with necrosis >30% ( P = 0.010) and Computed Tomographic Severity Index score ≥7 ( P = 0.048) predicting development of WON. Of the 84 patients with WON, 8 expired, 53 patients required an intervention, and 23 were managed conservatively. Independent predictors of any intervention among all patients were Computed Tomographic Severity Index score ≥7 ( P < 0.001) and interval between onset of pain to hospitalization >7 days ( P = 0.04). Conclusions: Patients with severe AP and delayed hospitalization more often develop acute collections. Pancreatic pseudocysts are a rarity in acute interstitial pancreatitis. A majority of patients with necrotising pancreatitis will develop ANC, more than half of whom will develop WON. Delay in hospitalization and higher baseline necrosis score predict need for intervention. Abstract : Supplemental Digital Content is available in the text