EARLY LOCALIZATION OF NECROSIS BY CONTRAST-ENHANCED COMPUTED-TOMOGRAPHY CAN PREDICT OUTCOME IN SEVERE ACUTE-PANCREATITIS

A total of 161 primary contrast-enhanced computed tomography (CT) scan s of patients with acute necrotizing pancreatitis taken between 1982 a nd 1994 were analysed retrospectively. The aim was to assess the progn ostic significance of the extent and anatomical site of pancreatic tis sue necrosis in the first contrast-enhanced CT scan. The scans were ob tained a mean of 2.9 days after the onset of symptoms, The pancreatic head was affected in 107 patients, the body in 119 and the tail in 138 , Pancreatic tissue necrosis, when divided into four groups according to anatomical site, correlated with overall clinical outcome. The anat omical site of necrosis was clearly better than its crude extent in pr edicting the risk of complications, For patients with necrosis in the head of the pancreas, the outcome was as severe as when the entire pan creas was affected. In contrast, for patients with necrosis only in th e distal part of the pancreas, the outcome was favourable with few com plications. The exact site of pancreatic tissue necrosis should be kno wn when early contrast-enhanced CT is used in prognostic scoring.