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13.10.2013, admin
2 clicks for more privacy: On the first click the button will be activated and you can then share the poster with a second click. MRI with diffusion-weighted sequence for pancreas evaluation in patients undergoing colangio-MRI.
Contrast is also seen in the gallbladder from a recent ERCP, another potential cause of acute pancreatitis. Patients with grades D or E had a mortality rate of 14%, compared with no mortality in patients with grades A, B or C (28).This CT grading system does not require intravenous contrast, which is its main draw back as it is unable to reliably predict pancreatic necrosis or make the distinction between acute fluid collections (AFCs) and pseudocysts versus post-necrotic fluid collections (PNFC), extrapancreatic necrosis (EXPN) and walled off pancreatic necrosis (WOPN). A major improvement in this grading system was the use of CE-CT, which has been able to overcome this problem.The CTSI assigns points to the percentage necrosis of the gland and to the Balthazar grade and combines these to produce a total severity score.

Up to 50% will resolve spontaneously, however the remainder become infected or develop into pseudocysts. They are systemic in nature and are a result of the release of pancreatic enzymes into the blood stream. They are usually round or oval and have a variable wall thickness and a non-epithelialised fibrous capsule. If possible, a retroperitoneal approach through the lateral flank is preferred to an anterior approach through the peritoneum. This should also aid drainage with gravity (33).The fluid contained in collections caused by pancreatic necrosis are often viscous therefore adequate drainage requires multiple side holes and large bore catheters (up to 20-24Fr).

Several catheters may be required to drain multi-loculated collections.Meticulous irrigation of these catheters should ideally be performed with sterile saline at least 3 times a day to prevent blockage. If a catheter is not draining but a residual collection is seen on CT, then the drain may be blocked and can be exchanged over a guidewire.Indications for catheter removal include no residual collection on follow up CT scan and when the drain output is non-purulent and less than 10ml per day on two consecutive days. Seen on the arterial phase of a contrast enhanced CT scan, they look like an ovoid contrast collection adjacent to the artery.

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