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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(04): 620-627
DOI: 10.1055/s-0044-1785683
Original Article

Tracking Wall Characteristics of Necrotic Pancreatic Fluid Collections in Acute Pancreatitis on Serial Contrast-Enhanced Computed Tomography

Harsimran Bhatia
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Joseph Johnson
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Pallavi T.
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Pankaj Gupta 
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Ajay Gulati
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Jimil Shah
2   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Anupam Singh
2   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Vaneet Jearth
2   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Jayanta Samanta 
2   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Harshal Mandavdhare
2   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Vishal Sharma 
2   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Saroj K. Sinha
2   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Usha Dutta
2   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Rakesh Kocchar
2   Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations Funding None.
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Abstract

Background Encapsulated pancreatic fluid collection (PFC) is a requisite for endoscopic drainage procedures. The 4-week threshold for defining walled-off necrosis does not capture the dynamic process of encapsulation. We aim to investigate the changes in the wall characteristics of PFC in acute necrotizing pancreatitis (ANP) by comparing baseline contrast-enhanced computed tomography (CECT) with follow-up CT scans.

Methods This retrospective study comprised consecutive patients with ANP who underwent a baseline CECT within first 2 weeks and follow-up CECT in the third to fifth weeks of illness. Presence, extent, and encapsulation thickness (defined as enhancing wall around the collection) on baseline CECT were compared with follow-up CT (done in the third–fifth weeks of illness).

Results Thirty patients (19 males and 11 females; mean age 41.5 ± 13.5 years) were included in the study. The mean time to first CECT was 10 ± 3.6 days. There were 58 collections. The most common site was the lesser sac (n = 29), followed by the left pararenal space (n = 15). At baseline CT, 52 (89.7%) collections had varying degree of encapsulation (15.3%, complete encapsulation). Complete encapsulation was seen in 52 and 82.6% collections in third and fourth week, respectively. All collections in fifth week and beyond were encapsulated. The wall was thicker on follow-up CECT scans (p < 0.01). The mean wall thickness was not significantly associated with the degree of encapsulation (p = 0.417). There was no significant association between the site and degree of encapsulation (p = 0.546).

Conclusion Encapsulation is dynamic and collections may get “walled off” before 4 weeks. Walled-off collections should be defined based on imaging rather than a fixed 4-week revised Atlanta classification threshold.

Keywords

acute necrotizing pancreatitis - computed tomography - endoscopic - necrosis


Publication History

Article published online:
03 May 2024

© 2024. 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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