To Prospectively Study the Outcome of Adult Patients With Acute Interstitial Pancreatitis, Acute Necrotizing Pancreatitis and Acute Pancreatitis With Extra-pancreatic Necrosis Alone

Abstract

Introduction: The correlation between extent of extra pancreatic necrosis with disease outcome in patients with acute pancreatitis remains unclear and was assessed in this prospective study that looked at the natural course of patients with acute interstitial pancreatitis (AIP), acute necrotizing pancreatitis (ANP) and Extra-pancreatic necrosis (EPN) alone. Methods: Seventy eight patients of acute pancreatitis [55 (70.5%) males; mean age: 41.8 [range (16-77) years] were prospectively observed till clinical recovery or death. Contrast-enhanced computerized tomography of the abdomen was done after day 5 of onset of symptoms and patients were categorized into 3 groups: AIP, ANP and EPN alone. EPN was termed extensive if it extended to paracolic gutters and/or pelvis. All groups were compared with respect to outcomes (surgery/intervention, organ failure and mortality). Results: Ten (12.8%) patients had interstitial pancreatitis, fifty one (65%) had pancreatic necrosis (PN) alone or combined with EPN and ten patients (12.8%) had EPN alone. Forty four patients (56.4%) developed organ failure, whereas 42 (53.8%) had persistent organ failure. Forty patients (51.3%) underwent an intervention and thirteen patents (16.7%) expired. Patients with EPN alone had higher occurrence of organ failure (20 % vs 0%), persistent organ failures (20% vs 0%), and need for intervention [30% vs 0 %] as compared to patients with AIP. Patients in PN group had higher frequency of ascites (64.7% vs 50%), pleural effusion (88.23% vs 70%), multi organ failure (27.4% vs 0%), persistent organ failure (72.5% vs 20%), need for intervention (66.7% vs 30%) and mortality (25.5% vs 0 %) than patients with EPN alone. Similarly patients with extensive EPN (n = 40) had significantly higher frequency of ascites (75% vs 38.1%), organ failure(82.5% vs 28.6%), multi-organ failure( 35% vs 0%) and persistent organ failure (82.5% vs 28.6%) than patients with limited EPN. However mortality (27.5% vs 9.5%) and need for intervention (62.5% vs 57.1%) was comparable in both groups.Figure: Extrapancreatic necrosis.Figure: Walled off necrosis formed from acute necrotic collection (Extrapancreatic necrosis).Conclusion: Patients of EPN alone have a clinical course that is severe than AIP but milder than PN and hence should be considered as a separate category. Patients with extensive EPN despite having higher frequency of multi-organ failure, persistent organ failure, ascites and pleural effusion have comparable mortality or need for intervention compared to patients with limited EPN.Figure: Flowchart Depicting Local Complications and Intervention Amongst Pancreatitis Patients.