ORIGINAL ARTICLE

JOP. J. Pancreas (Online) 2003; 4(6):207-213.

Angiographic Features in Acute Pancreatitis: The Severity of Abdominal Vessel Ischemic Change Reflects the Severity of Acute Pancreatitis

Kotaro Inoue, Masahiko Hirota, Toru Beppu, Takatoshi Ishiko, Yu Kimura, Keisuke Maeda, Michio Ogawa

Department of Surgery II, Kumamoto University Medical School. Kumamoto, Japan

ABSTRACT

Context Assessment of tissue microcirculation is one of the important aspects of pathological evaluation in acute pancreatitis. Severe ischemic change sometimes leads to the development of organ dysfunction and/or infectious complications.

Objective To evaluate the angiographic features of acute pancreatitis and correlate them with the severity of the disease.

Design Retrospective study.

Patients Twenty-seven consecutive patients with acute pancreatitis who had undergone angiography were retrospectively investigated.

Main outcome measures Vascular findings and Ranson score.

Results Ischemic changes were found in 18 patients (66.7%); 11 (40.7%) were severe changes. Pseudoaneurysm, bleeding, and staining were seen in 4 (14.8%), 2 (7.4%) and 5 (18.5%) patients, respectively. The rate of severe ischemic changes was significantly correlated with the Ranson score (P=0.012).

Conclusions Angiographic findings are useful for the evaluation of severe acute pancreatitis.

Full text: HTML format   PDF format
  Look up who cited this article

References

  1. Brisinda G, Maria G, Ferrante A, Civello IM. Evaluation of prognostic factors in patients with acute pancreatitis. Hepatogastroenterology 1999; 46:1990-7. [More details]

  2. Lankisch PG, Assmus C, Pflichthofer D, Struckmann K, Lehnick D. Which etiology causes the most severe acute pancreatitis? Int J Pancreatol 1999; 26:55-7. [More details]

  3. Toh SK, Phillips S, Johnson CD. A prospective audit against national standards of the presentation and management of acute pancreatitis in the south of England. Gut 2000; 46:239-43. [More details]

  4. Vesentini S, Bassi C, Talamini G, Cavallini G, Campedelli A, Pederzoli P. Prospective comparison of C-reactive protein level, Ranson score and contrast-enhanced computed tomography in the prediction of septic complications of acute pancreatitis. Br J Surg 1993; 80:755-7. [More details]

  5. Kemppainen E, Sainio V, Haapiainen R, Kivisaari L, Kivilaakso E, Puolakkainen P. Early localization of necrosis by contrast-enhanced computed tomography can predict outcome in severe acute pancreatitis. Br J Surg 1996; 83:924-9. [More details]

  6. Lukash WM. Complications of acute pancreatitis. Unusual sequelae in 100 cases. Arch Surg 1967; 94:848-52. [More details]

  7. Flaggl E, Heer M, Hany A, Branda L. Loss of vision as a complication of acute pancreatitis. Schweiz Med Wochenschr 1988; 118:722-5. [More details]

  8. Wei SC, Kao JH, Lee WY, Lin JT, Wang TH. Acute pancreatitis complicated by infarction of the spleen and spinal cord. J Formos Med Assoc 1997; 96:754-7. [More details]

  9. Kohli SC, Garg MK, Rohtagi S, Machve YV, Banerjee K. Acute pancreatitis with ischaemic heart disease-an abnormal electrocardiography. J Assoc Physicians India 1988; 36:452-4. [More details]

  10. Rice PF, Khan MS, Mackle EJ. Total splenic infarction in acute pancreatitis. J R Coll Surg Edinb 1996; 41:54-5. [More details]

  11. Minami T, Saito M, Yamamoto T, Kondo S, Ohmori O, Kanayama S. A case of hemolytic uremic syndrome and whole splenic infarction secondary to acute pancreatitis. J Gastroenterol Hepatol 2002; 17:1040-1. [More details]

  12. Mortele KJ, Mergo PJ, Taylor HM, Ernst MD, Ros PR. Splenic and perisplenic involvement in acute pancreatitis: determination of prevalence and morphologic helical CT features. J Comput Assist Tomogr 2001; 25:50-4. [More details]

  13. Bonham MJ, Abu-Zidan FM, Simovic MO, Windsor JA. Gastric intramucosal pH predicts death in severe acute pancreatitis. Br J Surg 1997; 84:1670-4. [More details]

  14. Slater G, Goldblum SE, Tzamaloukas AH, Jones WL, Goldhahn RT. Renal cortical necrosis and Purtscher's retinopathy in hemorrhagic pancreatitis. Am J Med Sci 1984; 288:37-9. [More details]

  15. Goldstein DA, Llach F, Massry SG. Acute renal failure in patients with acute pancreatitis. Arch Intern Med 1976; 136:1363-5. [More details]

  16. Lankisch PG, Droge M, Becher R. Pulmonary infiltrations. Sign of severe acute pancreatitis. Int J Pancreatol 1996; 19:113-5. [More details]

  17. Ranson JH. Etiological and prognostic factors in human acute pancreatitis: a review. Am J Gastroenterol 1982; 77:633-8. [More details]

  18. Ende N. Infarction of the bowel in cardiac failure. N Engl J Med 1958; 258:879-81. [More details]

  19. Hirota M, Inoue K, Kimura Y, Mizumoto T, Kuwata K, Ohmuraya M, et al. Non-occlusive mesenteric ischemia and its associated intestinal gangrene in acute pancreatitis. Pancreatology 2003; 3:316-22. [More details]

  20. Hirota M, Kimura Y, Ishiko T, Beppu T, Yamashita Y, Ogawa M. Visualization of the heterogeneous internal structure of so-called ‘pancreatic necrosis’ by magnetic resonance imaging in acute necrotizing pancreatitis. Pancreas 2002; 25:63-7. [More details]

  21. Aakhus T, Hofsli M, Vestad E. Angiography in acute pancreatitis. Acta Radiol Diagn 1969; 8:119-28. [More details]

  22. Reuter SR, Redman HC, Joseph RR. Angiographic findings in pancreatitis. Am J Roentgenol Radium Ther Nucl Med 1969; 107:56-64. [More details]

  23. Freeny PC, Ball TJ, Ryan J. Impact of new diagnostic imaging methods on pancreatic angiography. AJR Am J Roentgenol 1979 ;133:619-24. [More details]

  24. Ghosh BC, Mojab K, Esfahani F, Moss GS, Das Gupta TK. Role of angiography in the diagnosis of pancreatic neoplasms. Am J Surg 1979; 138:675-7. [More details]

  25. Kwaan HC, Anderson MC, Gramatica L. A study of pancreatic enzymes as a factor in the pathogenesis of disseminated intravascular coagulation during acute pancreatitis. Surgery 1971; 69:663-72. [More details]

  26. Takeda K, Matsuno S, Sunamura M, Kobari M. Surgical aspects and management of acute necrotizing pancreatitis: recent results of a cooperative national survey in Japan. Pancreas 1998; 16:316-22. [More details]

  27. Schetz M. Non-renal indications for continuous renal replacement therapy. Kidney Int 1999; 56:S88-94. [More details]

  28. Takeda K. Matsuno S, Sunamura M, Kakugawa Y. Continuous regional arterial infusion of protease inhibitor and antibiotics in acute necrotizing pancreatitis. Am J Surg 1996; 171:394-8. [More details]

  29. Takagi K, Isaji S. Therapeutic efficacy of continuous arterial infusion of an antibiotic and a protease inhibitor via the superior mesenteric artery for acute pancreatitis in an animal model. Pancreas 2000; 21:279-89. [More details]

Keywords Angiography; Mesenteric Vascular Occlusion; Pancreatitis; Pancreatitis, Acute Necrotizing

Correspondence Masahiko Hirota: mhirota@kaiju.medic.kumamoto-u.ac.jp