[Computer tomography as aid for surgical indication and choice of time in acute pancreatitis]

When initial clinical improvement of acute pancreatitis is followed by secondary deterioration, a local complication must be suspected, and surgery may be required to drain infected fluid collections and to debridge or resect necrotic and sequestering parts of the pancreas and/or peripancreatic fatty tissue. Clinical examination, laboratory investigations, and conventional radiology have failed to give clear information as to the local process in the retroperitoneum. The indication for surgery has therefore traditionally been based upon the systemic manifestations of sepsis and distant organ failure, which may account for the still high mortality in this group of patients. Computerised axial tomography (CT) has been shown to be of value in making an earlier diagnosis of the local complications of acute pancreatitis and providing more detailed informations upon which to base the type and extent of the surgical procedure. In the last 1 1/2 years CT has been used prospectively by the authors for initial assessment and follow-up of the course in all cases of severe acute pancreatitis. In this series 3 out of 11 operated patients died, compared to 18 out of 33 comparable cases during the preceding 5-year period when CT was not available in our hospital. In 2 of the 3 fatalities, a perforation of the colon had been present at the time of referral. These preliminary results suggest that CT is of value in the management of this difficult problem and has helped to reduce mortality from the complications of acute pancreatitis.