Influence of contrast-enhanced computed tomography on course and outcome in patients with acute pancreatitis.
BACKGROUND
Many of the complications in severe acute pancreatitis result from the amplifying effects of microcirculatory disruption. Contrast medium may cause significant additional reductions of capillary flow, which has been shown to aggravate acute pancreatitis in experimental studies.


OBJECTIVE
To investigate the role of serial contrast-enhanced computed tomography (CECT) in patients with acute pancreatitis.


METHODS
A retrospective analysis evaluated 302 patients with moderate to severe acute pancreatitis. Among these patients, 264 underwent CECT within 96 hours of the onset of symptoms and again during the course, but in 38 patients no serial CECT was performed. Outcome measurement was analyzed by comparison of hospital stay and mortality rate between the two patient groups. Influences of contrast medium on severity of disease were detected by monitoring complications during the course of treatment, C-reactive protein, and APACHE II score.


RESULTS
The 1-month mortality rate was less in patients with CECT (6.4% versus 15.8%, p <0.05). There were no significant differences considering the incidence of additional complications, and hospital stay was not significantly longer (29 +/- 36 versus 19 +/- 13 days). C-reactive protein and APACHE II score had similar time courses.


CONCLUSIONS
Contrast-enhanced computed tomography remains crucial in identifying patients with acute pancreatitis at high risk to develop necrosis of the pancreas and systemic complications. Contrast medium has been found to aggravate acute pancreatitis in animal models. As compared with the patient group without being exposed to contrast medium, however, this study did not show a deterioration of acute pancreatitis by administration of contrast medium in men.
Uhl
Waldemar
W
Department of Visceral and Transplantation Surgery, University of Bern, Switzerland.
Roggo
Antoine
A
Kirschstein
Timo
T
Anghelacopoulos
S E
SE
Gloor
Beat
B
Müller
Christophe A
CA
Malfertheiner
Peter
P
Büchler
Markus W
MW
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D003287:Contrast Media