Diagnosis of necrotizing pancreatitis using contrast-material-enhanced CT

Contrast-enhanced CT plays an integral role in the medical and surgical evaluation of patients with acute pancreatitis. This CT study can confirm the diagnosis in patients in whom the clinical diagnosis may be in doubt; moreover, it can evaluate the presence and extent of severe (necrotizing) pancreatitis and/or other complications (fluid collections, pseudocysts, pseudoaneurysm, etc.). CT-guided needle aspiration is useful in making an objective diagnosis of infected necrosis and in placing drainage catheters in selected patients with infected fluid collections or symptomatic pseudocysts. Patients are selected for operative intervention on the basis of clinical findings (sepsis, documented infected necrosis). No CT finding in isolation determines whether operative intervention is indicated or not, except possibly the finding of extraluminal gas in the appropriate clinical setting. Rather, in the setting of acute pancreatitis, contrast-enhanced CT provides morphologic evaluation of the pancreatic gland and guidance for needle aspiration, both of which play an important role in guiding patient management. In the patient requiring operative intervention, CT delineates all the areas of necrosis requiring debridement and thereby serves as an important map for the operating surgeon.