Aims and objectives
Acute pancreatitis is a clinical disease with a broad spectrum of severity.
Its pathogenesis stems from premature activation of pancreatic enzymes that causes the autodigestion of pancreatic parenchyma and neighboring tissues [1-3].
Extravasation of enzymes like lipase,
phospholipase,
and other pancreatic enzymes can induce necrosis of intra-abdominal fatty tissues [1-4].
In pancreatitis,
fat necrosis could be observed in peripancreatic,
mesenterial and retroperitoneal fat [5].
To the best of our knowledge,
the radiological profile of post pancreatitis intra-abdominal fat necrosis (IAFN) was not adequately highlighted in...
Methods and materials
Patient population: All CT scans of patients with acute pancreatitis (Balthazar B -E) between September 2015 and July 2018 were analyzed.
Exclusion criteria were: patients diagnosed with acute pancreatitis Balthazar A,
patients with clinical history of abomino-pelvic malignancies,
and patients with acute pancreatitis without CT-follow-up.
Data acquisition: All patients were examined by contrast enhanced CT of the abdomen and pelvis following clinical or laboratory suspicion of acute pancreatitis.
All images were analyzed in consensus by two board certified radiologists.
Additionally,
Medical files were reviewed for...
Results
Two hundred seven patients with acute pancreatitis were identified.
Of those,
24 (12%) presented with typical radiological pattern of IAFN.
There were 13 males and 11 females,
with a mean age 61.5 y ± 14 (range 14-84 y).
IAFN grade I was observed in 14 patients,
grade II in 4 patients,
and grade III in 6 patients.
The appearance of IAFN was within 3 weeks after establishing the diagnosis of acute pancreatitis (mean 8.3 day ± 6).
Worth noting is that the left flank was...
Conclusion
Acute pancreatitis induced IAFN is observed in up to 12% of patients along their disease course.
This self-regressing process must be clearly identified and reported to avoid mistaking it for other more serious abdominal pathologies like peritoneal carcinomatosis or liposarcomas.
References
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Radiology 223(3):603-613.
Balthazar EJ (2002) Complications of acute pancreatitis: clinical and CT evaluation.
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Kamaya A,
Federle MP,
Desser TS (2011) Imaging manifestations of abdominal fat necrosis and its mimics.
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Noel P,
Patel K,
Durgampudi C,
Trivedi R et al (2016) Peripancreatic fat necrosis worsens acute pancreatitis independent of pancreatic necrosis via unsaturated fatty acids increased in human pancreatic necrosis collections.
Gut 65(1):100-111.
Franco-Pons N,
Gea-Sorli...