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Computed Tomography Findings in Intraabdominal Hypertension in Patients with Acute Pancreatitis
Purpose Intraabdominal hypertension (IAH) in acute pancreatitis (AP) may reduce tissue perfusion and impair organ function and has been shown to portend poor prognosis. We investigated the computed tomography (CT) findings in patients with AP with IAH.
Methods This retrospective study comprised of consecutive patients with AP from June 2016 to June 2018 in whom intraabdominal pressure (IAP) was measured. The patients who underwent a contrast-enhanced CT within 7 days of IAP measurement were included. Using a cutoff of 12 mm Hg for IAP, the patients were divided into IAH and non-IAH groups. Measures of severity and clinical outcome were evaluated. CT parameters were compared between the groups.
Results The IAH group comprised of 41 patients, while there were 20 patients in the non-IAH group. The IAH group was characterized by severe disease, increased incidence of organ failure, increased requirement for drainage and surgery, prolonged hospital and intensive care unit stay. The mortality was not significantly different between the two groups. On univariate analysis, the CT features that were found to be significantly different between the two groups were the presence of collection (p = 0.036), the maximum dimension of collection (p = 0.004), volume of collection (p = 0.019), biliary dilatation (p = 0.011), and the presence of moderate-to-severe pleural effusion (p = 0.009). On multivariate analysis, all these parameters except biliary dilatation were found to be statistically significant.
Conclusion CT findings in patients with AP may suggest IAH. This can be used as an additional marker for severity of AP.
Keywordsacute pancreatitis - abdominal compartment syndrome - computed tomography - intraabdominal hypertension
23 May 2021 (online)
© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Al-Bahrani AZ, Abid GH, Holt A. et al. Clinical relevance of intra-abdominal hypertension in patients with severe acute pancreatitis. Pancreas 2008; 36 (01) 39-43
- 2 Chen H, Li F, Sun J-B, Jia J-G. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage. World J Gastroenterol 2008; 14 (22) 3541-3548
- 3 Dambrauskas Z, Parseliunas A, Gulbinas A, Pundzius J, Barauskas G. Early recognition of abdominal compartment syndrome in patients with acute pancreatitis. World J Gastroenterol 2009; 15 (06) 717-721
- 4 Gupta P, Rana P, Bellam BL. et al. Site and size of extrapancreatic necrosis are associated with clinical outcomes in patients with acute necrotizing pancreatitis. Pancreatology 2020; 20 (01) 9-15
- 5 Bansal A, Gupta P, Singh H. et al. Gastrointestinal complications in acute and chronic pancreatitis. JGH Open 2019; 3 (06) 450-455
- 6 Aitken EL, Gough V, Jones A, Macdonald A. Observational study of intra-abdominal pressure monitoring in acute pancreatitis. Surgery 2014; 155 (05) 910-918
- 7 Singh AK, Samanta J, Dawra S. et al. Reduction of intra-abdominal pressure after percutaneous catheter drainage of pancreatic fluid collection predicts survival. Pancreatology 2020; 20 (04) 772-777
- 8 Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment syndrome. Surg Clin North Am 1996; 76 (04) 833-842
- 9 Sugerman HJ, Bloomfield GL, Saggi BW. Multisystem organ failure secondary to increased intraabdominal pressure. Infection 1999; 27 (01) 61-66
- 10 Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 2000; 49 (04) 621-626, discussion 626–627
- 11 Kumar P, Gupta P, Rana S. Thoracic complications of pancreatitis. JGH Open 2018; 3 (01) 71-79
- 12 Maerz L, Kaplan LJ. Abdominal compartment syndrome. Crit Care Med 2008; 36 (Suppl. 04) S212-S215
- 13 Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med 1987; 15 (12) 1140-1142
- 14 Pickhardt PJ, Shimony JS, Heiken JP, Buchman TG, Fisher AJ. The abdominal compartment syndrome: CT findings. AJR Am J Roentgenol 1999; 173 (03) 575-579
- 15 Epelman M, Soudack M, Engel A, Halberthal M, Beck R. Abdominal compartment syndrome in children: CT findings. Pediatr Radiol 2002; 32 (05) 319-322
- 16 Al-Bahrani AZ, Abid GH, Sahgal E, O’shea S, Lee S, Ammori BJ. A prospective evaluation of CT features predictive of intra-abdominal hypertension and abdominal compartment syndrome in critically ill surgical patients. Clin Radiol 2007; 62 (07) 676-682
- 17 Wachsberg RH, Sebastiano LL, Levine CD. Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure. Abdom Imaging 1998; 23 (01) 99-102
- 18 Malbrain MLNG, Cheatham ML, Kirkpatrick A. et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. definitions. Intensive Care Med 2006; 32 (11) 1722-1732
- 19 Gupta P, Jain R, Koshi S. et al. Radiation dose from computed tomography in patients with acute pancreatitis: an audit from a tertiary care referral hospital. Abdom Radiol (NY) 2020; 45 (05) 1517-1523
- 20 Gupta P, Dawra S, Chandel K. et al. Fat-modified computed tomography severity index (CTSI) is a better predictor of severity and outcome in patients with acute pancreatitis compared with modified CTSI. Abdom Radiol (NY) 2020; 45 (05) 1350-1358
- 21 Gupta P, Chayan Das G, Sharma V. et al. Role of computed tomography in prediction of gastrointestinal fistula in patients with acute pancreatitis. Acta Gastroenterol Belg 2019; 82 (04) 495-500
- 22 Mallick B, Dhaka N, Gupta P. et al. An audit of percutaneous drainage for acute necrotic collections and walled off necrosis in patients with acute pancreatitis. Pancreatology 2018; 18 (07) 727-733
- 23 Jolles H, Coulam CM. CT of ascites: differential diagnosis. AJR Am J Roentgenol 1980; 135 (02) 315-322
- 24 Mortele KJ, Wiesner W, Intriere L. et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol 2004; 183 (05) 1261-1265
- 25 Maringhini A, Ciambra M, Patti R. et al. Ascites, pleural, and pericardial effusions in acute pancreatitis. A prospective study of incidence, natural history, and prognostic role. Dig Dis Sci 1996; 41 (05) 848-852
- 26 Samanta J, Rana A, Dhaka N. et al. Ascites in acute pancreatitis: not a silent bystander. Pancreatology 2019; 19 (05) 646-652
- 27 Ke L, Ni HB, Sun JK. et al. Risk factors and outcome of intra-abdominal hypertension in patients with severe acute pancreatitis. World J Surg 2012; 36 (01) 171-178
- 28 Gupta P, Virk M, Gulati A. et al. Unusual sites of necrotic collections in acute necrotizing pancreatitis: association with parenchymal necrosis and clinical outcomes. Dig Dis Sci 2020; •••: Epub ahead of print DOI: 10.1007/ S10620–020–06526–6.
- 29 Gupta P, Kumar-M P, Verma M. et al. Development and validation of a computed tomography index for assessing outcomes in patients with acute pancreatitis: “SMART-CT” index. Abdom Radiol (NY) 2020; •••: Epub ahead of print DOI: 10.1007/s00261-020-02740-y.
- 30 Zhao JG, Liao Q, Zhao YP, Hu Y. Mortality indicators and risk factors for intra-abdominal hypertension in severe acute pancreatitis. Int Surg 2014; 99 (03) 252-257
- 31 Gupta P, Gupta J, Kumar C. et al. Aggressive percutaneous catheter drainage protocol for necrotic pancreatic collections. Dig Dis Sci 2020; 65 (12) 3696-3701
- 32 Gupta P, Koshi S, Samanta J. et al. Kissing catheter technique for percutaneous catheter drainage of necrotic pancreatic collections in acute pancreatitis. Exp Ther Med 2020; 20 (03) 2311-2316