Contrast-enhanced computed tomography in acute pancreatitis: Does contrast medium worsen its course due to impaired microcirculation?

Jan A. Plock, Joachim Schmidt, Suzanne E. Anderson, Michael G. Sarr, Antoine Roggo

Research output: Contribution to journalReview article

11 Scopus citations

Abstract

Background: An early and accurate diagnosis of severe acute (necrotizing) pancreatitis is important to allow timely institution of therapy to limit the extra-pancreatic sequelae of this necrotizing process and to minimize the incidence of super-infection of the necrosis (i.e., progression to infected necrosis). Contrast-enhanced computed tomography (CECT) has become the cornerstone of diagnosis by confirming the clinical diagnosis of severe acute pancreatitis based on the various clinical scoring criteria. Moreover, CECT serves as an anatomic roadmap for guiding radiological and surgical interventions. However, still-controversial experimental studies in animals in the mid-1990s suggested that the use of intravenous radiographic contrast media early in the course of the disease might exacerbate the necrotizing process by further impairing the already compromised pancreatic microcirculation. A series of experimental and clinical studies followed that have both refuted and supported this claim; unfortunately, none is conclusive, and the topic remains, as yet, unresolved. Aims: Our objective was to review objectively the available literature found by a Medline search on this subject. Methods: Meta-analysis and review. Results and conclusion: Our conclusion, after analysis of these studies, is that there are no well-substantiated data that could resolve the controversy. However, several caveats will be offered.

Original languageEnglish (US)
Pages (from-to)156-163
Number of pages8
JournalLangenbeck's Archives of Surgery
Volume390
Issue number2
DOIs
StatePublished - Apr 1 2005

Keywords

  • Acute pancreatitis
  • Computed tomography
  • Contrast medium
  • Microcirculation

ASJC Scopus subject areas

  • Surgery

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