Serial computed tomography is rarely necessary in patients with acute pancreatitis: A prospective study in 102 patients

BACKGROUND. CT has proved to be helpful in patients with acute pancreatitis for differentiating between mild and severe forms. Followup of acute pancr eatitis with CT has been advocated but rarely studied. The aim of this stud y was to determine if late CT performed at day 7 might be helpful in establ ishing the prognosis or the type of complications, and to select a subgroup of patients in whom CT could be beneficial. STUDY DESIGN: Contrast-enhanced CT was performed at the admission day and 7 days after admission in 102 patients admitted for acute pancreatitis. The extent of pancreatic inflammation was classified according to Balthazar gra de, and intrapancreatic necrosis on these examinations was prospectively as sessed and compared with clinical and biologic data and with patient outcom es. RESULTS: Among 102 patients, complications developed in 24 (23%). Complicat ions developed in only 8% of patients with Ranson score <2, making routine early CT unnecessary. For the patients with Ranson score <2 and Balthazar g rades A and B at day 1 CT, late CT seemed to be useless. Complication was s uspected by clinical and biologic tests before day 7 in 22 of 24 complicate d patients (92%), suggesting that CT could be proposed only in cases of cli nical or biologic deterioration. Late CT was correlated with a complicated course in patients with Balthazar grades D and E or intrapancreatic necrosi s >50%. Late CT was predictive of complications in cases of intrapancreatic necrosis enlarging since the first examination. CONCLUSIONS: Our study showed that in acute pancreatitis: 1) there is littl e justification for systematic early CT, especially in patients with Ranson score <2, and 2) late CT does not need to be performed routinely, but only in cases of clinical or biologic worsening. (J Am Coll Surg 2001;193: 146- 152. (C) 2001 by the American College of Surgeons).