EARLY COMPUTERIZED TOMOGRAPHIC SCAN IN MILD PANCREATITIS MAY BE DECEIVING: AN EXPERIENCE OF TERTIARY CARE HOSPITAL

Objective: To assess the justification of Computerized Tomographic (CT) scan for the diagnosis of acutepancreatitis at early stage and its impact on mortality and morbidity of patientsMethodology: It was a retrospective study conducted at Radiology Department Dow University of HealthSciences from April 2009 to August 2011. Patients were diagnosed as acute pancreatitis both clinically andradiologically. Severity of acute pancreatitis was clinically assessed by Ranson s criteria andradiologically by Balthazar CT Grading and CT Severity Index.Results: Fourteen of the total 131 included patients underwent early CT scan at 4-12 hour after start ofsymptoms of abdominal pain and vomiting and were normal radiologically(10.68% out of total 131patients presented with acute pancreatitis. These patients revisited at 24-36 hours, with severe epigastricpain and on follow-up CT scan on re-admission, two patients showed intra and peripancreatic collections,swollen pancreas with peripancreatic fat necrosis without necrotizing pancreatitis (Balthazar Grade-E) andmoderate pancreatitis according to CT Severity Index(four points); Three patients had 30% pancreaticnecrosis with Balthazar grade-E changes and according to CT Severity Index moderatepancreatitis(2+4=6); Two patients had 30-50% necrosis and rated as Balthazar Grade-E and labeled assevere necrotizing pancreatitis according to CT Severity Index(4+4=8); while Seven patients showed severenecrotizing pancreatitis with 50% of pancreatic necrosis according to CT Severity Index(6+4) along withBalthazar Grade-E pancreatitis(6+4=10). Patients with severity index of 10 had 100% mortality.Conclusion: Early CT scan has very little role in diagnosing and determining severity of disease or inpredicting prognosis of patients.