J Korean Soc Radiol.  2019 Jul;80(4):704-716. 10.3348/jksr.2019.80.4.704.

Utility of Early CT in Patients with Suspected Acute Biliary Pancreatitis

• Yoon S
• Park SH
• Jeong YM
• Choi SJ
• Shim Y
• Hong MJ
• Cho JH
• Kim YS

• KMID: 2457448
• DOI: http://doi.org/10.3348/jksr.2019.80.4.704

Abstract

PURPOSE
The purpose of this study was to investigate whether early CT scans are useful for improving the clinical management of acute biliary pancreatitis.
MATERIALS AND METHODS
We retrospectively reviewed 56 consecutive patients who experienced first attack of acute pancreatitis and underwent CT scans within 48 hours of symptom onset in the emergency department, between March 2015 and March 2016. CT images were retrospectively evaluated for absence or presence, and etiology of acute pancreatitis, and probability of biliary pancreatitis. Urgent procedures for acute pancreatitis were analyzed.
RESULTS
Of 56 patients, 54 (96.4%) showed acute pancreatitis and 23 (41.1%) had biliary pancreatitis on CT. The diagnostic accuracy, sensitivity, and specificity of CT-diagnosed biliary pancreatitis were 94.6% (53/56), 91.7% (22/24), and 96.9% (31/32), respectively. Of the 56 patients, 17 (30.4%) patients with biliary pancreatitis underwent urgent endoscopic retrograde cholangiopancreatography (ERCP) within 72 hours (mean time interval between CT and ERCP: 25.5 ± 19.8 hours; range: 2-67 hours). There was a significant difference in the urgent procedures between non-biliary and biliary pancreatitis groups (0 of 32 vs. 17 of 24, p < 0.001).
CONCLUSION
Early CT may be used in patients visiting hospital with suspected acute biliary pancreatitis to facilitate urgent treatment.

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Diagnostic Imaging
Emergency Service, Hospital
Humans
Pancreatitis*
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 False-negative biliary pancreatitis in a 55-year-old woman observed on early CT. Contrast-enhanced CT scans (A–C) reveal mild common bile duct wall thickening (arrow, A) and small collections of peripancreatic fluid (arrows, C) (classification of acute pancreatitis, 1; etiology of acute pancreatitis, 0; probability of biliary pancreatitis, 1). The time interval from symptom onset to CT was 5 hour. The patient had no history of alcohol abuse. The physician performed endoscopic ultrasound to evaluate the cause of acute pancreatitis and confirmed a large amount of gall bladder sludge (D). ERCP (time interval between CT and ERCP: 90 hour) was performed and the biliary sludge was removed (E, F); infundibulostomy was implemented (F). CT = computed tomography, ERCP = endoscopic retrograde cholangiopancreatography

• 

  Fig. 2 Biliary pancreatitis in a 75-year-old man who had undergone cholecystectomy. The time interval from symptom onset to CT was 12 hour. Contrast-enhanced coronal images show a small high-density lesion in the CBD (arrow, A) with CBD dilatation and wall thickening (arrow, B), suggesting the presence of a CBD stone with mild cholangitis. Axial scans (arrows, C, D) show small collections of peripancreatic fluid (classification of acute pancreatitis, 1; etiology of acute pancreatitis, 1; probability of biliary pancreatitis, 3). The physicians performed an urgent ERCP (time interval between CT and ERCP: 9 h) and removed the biliary stones (arrow, E, F), after which endoscopic sphincterotomy was performed. CBD = common bile duct, CT = computed tomography, ERCP = endoscopic retrograde cholangiopancreatography

• 

  Fig. 3 Biliary pancreatitis in a 59-year-old man. The time interval from symptom onset to CT was 6 h. Non-enhanced axial images show a common bile duct stone (arrow, A) with a GB stone (arrow, B). Contrast-enhanced axial images (arrows, C, D) show GB wall thickening with transient hyperemic attenuation difference around the GB fossa, suggesting acute cholecystitis and a small amount of peripancreatic fluid collection (classification of acute pancreatitis, 1; etiology of acute pancreatitis, 1; probability of biliary pancreatitis, 3). The physician performed an urgent ERCP (time interval between CT and ERCP: 22 h) and removed the biliary stones (arrow, E, F). Endoscopic sphincterotomy was performed. CT = computed tomography, ERCP = endoscopic retrograde cholangiopancreatography, GB = gall bladder

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