[Diagnosis of necrotizing pancreatitis. Comparison between contrast medium-computed tomography and ultrasonics in a...

Contrast-enhanced computed tomography and (or) sonography was carried out preoperatively in 93 patients undergoing operation for the treatment of severe acute pancreatitis. 77 patients presented with necrotising pancreatitis and 16 with interstitial oedematous pancreatitis predominantly due to biliary causes. The surgical principle involved necrotomy, continuous post-operative bursal lavage or biliary sanitation and (or) pancreas drainage in the case of interstitial oedematous pancreatitis. Sensitivity of contrast-enhanced CT in necrotising pancreatitis was 85%, in localised necrosis 79%, and in extensive necrosis 89.5%. Sonography was negative in 24% of patients and in 37% of those with severe necrotising processes due to extensive masking by intestinal gas. If successful, its sensitivity was 73% only. Thus, sonography is unsuitable for the diagnosis of severe, especially necrotising, pancreatitis; it should be used for confirming the diagnosis and for monitoring the course of mild pancreatitis. Contrast-enhanced CT is indicated for suspected cases involving the necrotising form of the disease, where extensive pancreatic necrosis is registered with high reliability. Controls are advisable for cases with localised pancreatitis.