title: Clinical significance of presence and extent of extrapancreatic necrosis in acute pancreatitis.
abstract: OBJECTIVE
  Extrapancreatic necrosis (EPN) alone represents a subgroup of pancreatitis with better outcome than patients with pancreatic parenchymal necrosis (PN). However, data on clinical significance of EPN is limited, and significance of the extent of EPN is not known.
  
  
  METHODS
  Two hundred thirteen patients (136 [63.8%] males; mean age: 39.8 ± 13.2 years) with acute pancreatitis were prospectively enrolled and followed up till recovery or death. Contrast-enhanced computed tomography of each patient was retrospectively evaluated for presence of PN and EPN, pleural effusion and ascites. EPN was termed extensive if it extended to paracolic gutters or pelvis.
  
  
  RESULTS
  Twenty-one (9.9%) patients had interstitial pancreatitis, seven (3.3%) patients had PN alone, 48 (22.5%) patients had EPN alone, and 137 (64.3%) patients had combined PN and EPN. Patients with EPN alone had significantly higher frequency of organ failure than patients with interstitial pancreatitis. Compared with patients with EPN alone, the patients with combined necrosis had significantly higher frequency of pleural effusion (88.2% vs. 75%), ascites (41% vs. 20.8%), and need for intervention (32.6% vs. 14.6%). Patients with extensive EPN (n = 57) had significantly higher frequency of pleural effusion, ascites, and multi-organ failure than those with limited EPN.
  
  
  CONCLUSIONS
  EPN alone should be considered as a separate category of acute pancreatitis as it has less severe course than PN but has more severe course than interstitial pancreatitis. Patients with extensive EPN in spite of having increased frequency of ascites, pleural effusion, and multi-organ failure had similar outcome as compared to patients with limited EPN.
authors.affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Rana
authors.forename: Vishal
authors.initials: V
authors.lastname: Sharma
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Sharma
authors.forename: Puneet
authors.initials: P
authors.lastname: Chhabra
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Bhasin
mesh_terms: D000208:Acute Disease; D000328:Adult; D001201:Ascites / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D009336:Necrosis; D010179:Pancreas / Q000473:pathology*; D010195:Pancreatitis / Q000150:complications* / Q000473:pathology*; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: acute pancreatitis; alcohol; ascites; gall stones; idiopathic pancreatitis; necrosis