Complication Of Acute Pancreatitis Research Articles

Development of a nomogram for predicting pancreatic portal hypertension in patients with acute pancreatitis: a retrospective study

IntroductionPancreatic portal hypertension (PPH) is a rare complication of acute pancreatitis (AP) that can lead to severe gastrointestinal bleeding. The risk factors associated with PPH, as well as the overall...

Association Between Body Composition Measured by Artificial Intelligence and Long-Term Sequelae After Acute Pancreatitis.

The clinical utility of body composition in the development of complications of acute pancreatitis (AP) remains unclear. We aimed to describe the associations between body composition and the recurrence of AP. We performed a retrospective study of patients hospitalized with AP at three tertiary care centers. Patients with computer tomography (CT) imaging of the abdomen at admission were included. A previously validated and fully automated abdominal segmentation algorithm was used for body composition analysis. Hospitalization for a recurrent episode of AP was the primary endpoint. Secondary endpoints included the development of chronic pancreatitis (CP) or diabetes mellitus (DM) in patients who were evaluated. Cox Proportional Hazards regression was used. From a total of 347 patients, 89 (25.6%) were hospitalized for recurrent AP (median time: 219days). Thirty-four of 112 patients (30.4%) developed CP (median time: 311days) and 22 of 88 (25.0%) developed DM (median time: 1104days). After adjusting for age, male sex, first episode of AP, BUN, and severity of AP, we found that obesity, body mass index, alcohol pancreatitis, and gallstone pancreatitis were significantly associated with a recurrent episode of AP. Body composition was not associated with recurrent AP. In unadjusted analysis, subcutaneous adipose tissue (SAT) (HR 0.87 per 10 cm2, p = 0.002) was associated with CP. Skeletal muscle (SM) mass approached significance for CP (p = 0.0546). Intermuscular adipose tissue (IMAT) (HR 1.45 per 5 cm2, p = 0.0264) was associated with DM. Body composition was not associated with having a recurrent AP. At follow-up, 30% and 25% of evaluated patients developed CP and DM, respectively. A higher SAT and IMAT were associated with a lower incidence of CP and higher incidence of DM, respectively.

Prevention of Infectious Complications in Acute Pancreatitis

AIM OF STUDY. The study was aimed to evaluate the effectiveness of treating acute pancreatitis by early enteral nutrition and selective introduction of nutritional mixtures directly into the initial sections of the jejunum, bypassing the duodenum.MATERIAL AND METHODS. A comprehensive treatment method for acute pancreatitis was developed based on the use of a pancreatoduodenal catheter. The method focuses on preventing intestinal failure syndrome by isolating the duodenum and preventing any liquid from entering it while ensuring the selective introduction of glucose-saline solutions and/or enteral nutritional mixtures directly into the initial sections of the jejunum. Several Russian clinics are currently conducting the research approved by local ethics committees. This article presents preliminary results from the data analysis. The study included moderate to severe forms (according to the 2012 Atlanta classification) of acute biliary pancreatitis without indications for endoscopic retrograde cholangiopancreatography, as well as alimentary-alcoholic pancreatitis. The first group of patients received standard therapy according to the 2020 clinical guidelines of the Russian Society of Surgeons. The second group received standard therapy combined with the new selective enteral nutrition method. The observation period lasted until the end of the hospital treatment, including five mandatory visits and a final visit to the physician. A follow-up survey was conducted three months or more after discharge to identify delayed episodes of acute pancreatitis complications, focusing on the incidence of infectious complications and surgical interventions.RESULTS. A total of 148 patients were treated. Patients were evenly distributed by etiology, gender, age, and body mass index. The analysis revealed that the number of patients with infectious complications decreased from 19.3% in the comparison group to 6.67% in the study group (p=0.041). The number of patients requiring surgical interventions was 5.0% in the study group compared to 19.3% in the comparison group (p=0.017).CONCLUSIONS. The study demonstrated that the use of the new method in the comprehensive treatment of acute pancreatitis, including early enteral feeding at the onset of the disease, may improve the course of the disease by reducing the incidence of infectious complications and the number of necessary surgical interventions.

Type 3c diabetes mellitus: what are we dealing with? Review

The authors presented updated data on the term «type 3 diabetes mellitus», its modern classification, pathophysiological mechanisms of development and features of treatment, its definitions, epidemiology and modern classification based on the recommendations of the American Diabetes Association. Definitions and epidemiological features of acute pancreatitis and its most frequent complications, including 3c type diabetes have been described. Statistical data were presented on the risk of developing complications of acute pancreatitis in the form of carbohydrate metabolism disorders. Historical prerequisites of fatal complications of acute pancreatitis in the form of hyperglycemic states were also described. The pathophysiological mechanisms of the development of type 3c diabetes, namely local and systemic inflammation, loss of islet tissue of the pancreas, dysregulation of the insulin­­incretin axis, autoimmune destruction of β­cells of the pancreas, etc. were highlighted in detail. The role of genetic factors in the development of diabetes against the background of acute pancreatitis is described. Currently there are no standardized unified criteria of type 3c diabetes, thus the main and additional diagnostic criteria according to the different authors have been analyzed in detail. The differential characteristics and features of the diagnosis of diabetes mellitus by type and peculiarities of the diagnosis of type 1, 2 and 3c diabetes mellitus have been presented. The discussion on the glycemic target goals for patients with type 3c diabetes and the need for screening and prevention of carbohydrate metabolism disorders in patients with acute pancreatitis has been outlined. The authors provided current recommendations for the treatment of type 3c diabetes and discussed the possibilities of the use of insulin in the basis/bolus mode to achieve compensation of carbohydrate metabolism. The necessity to compensate pancreas exocrine insufficiency to improve the assimilation of fats and fat‑soluble vitamins has been emphasized.

Multiple giant pancreatic pseudocysts, a rare complication of acute pancreatitis – A case report

A 34-year-old alcoholic male presented to our outpatient department with a complaint of persistent epigastric pain, radiating to the back with a swelling in the upper abdomen. He had 2 similar episodes in the past for which he was conservatively managed along the lines of acute pancreatitis. Now on physical examination, the patient had a massive lump in the upper abdomen reaching below the umbilicus. Examination findings were confirmed by computed tomography - abdomen (Plain and Contrast), two 13×10×09 cm and 9×8×7.8 cm, cystic lesions (Noncommunicating) were seen abutting the posterior wall of the stomach and into each other, suggestive of mature pseudocysts of the pancreas. The patient was admitted and after necessary investigations, surgical cystogastrostomy was done for the lower pseudocyst and cystocystostomy for the upper pseudocyst. The patient was discharged 5 days later with no complications. This case shows that multiple pseudocysts, a relatively rare complication of acute pancreatitis, are one of the differentials of acute abdomen. The treatment is a therapeutic challenge that depends on location, size, number as well as their relation to one another. Good drainage prevents resection procedures and further complications (exocrine and endocrine insufficiency).

Natural History and Microbiological Profiles of Patients With Acute Pancreatitis With Suspected Infected Pancreatic Necrosis.

Acute pancreatitis (AP) is a prevalent emergency. The clinical spectrum of the condition is varied, ranging from a mild to a malignant course with higher mortality rates. Infection of pancreatic/peri necrosis, extrapancreatic infections, and organ failure are significant complications in AP. In the recent era, microbiological composition has shifted more towards multi-drug-resistant organisms due to irrational antibiotic use. This study aims to understand the natural history of patients with suspected infected pancreatic necrosis (IPN), the prevalence of multi-drug-resistant organisms (MDROs), and their antibiotic susceptibility patterns. This prospective, observational study was performed on 130 cases of acute necrotizing pancreatitis (ANP) with suspected IPN that were evaluated during their period of admission in the department of gastroenterology, emergency medicine, or surgery ward of thePostgraduate Institute of Medical Education and Research, Chandigarh, India, a tertiary hospital. The details of outcomes were recorded. The organisms in cases with IPN and antibiotic resistance patterns of various organisms were studied. The most prevalent site of necrosis was combined pancreatic and peripancreatic tissues in 111 (85.4%) patients. The computed tomography severity index (CTSI) had a mean of 8.72±1.43. Of all participants, 36 (27.7%) patients had <30% necrosis, 47 (36.2%) had 30%-50% necrosis, and 47 (36.2%) had >50% necrosis. Overall, 80 (61.5%) patients had organ failure, with acute lung injury (ALI) being the most common. Rates of complications were markedly greater in cases with higher pancreatic necrosis and with infected necrosis (p<0.05). The most common organism isolated from necrotic tissue was Escherichia coli (E. coli) in 17 (32.07%) cases, followed by Acinetobacter baumannii (A. baumannii) in 12 (22.64%) cases. The most common extrapancreatic infection site was respiratory tract infections. Pseudomonas aeruginosa (P. aeruginosa) and A. baumannii revealed maximum resistance to most of the drugs. Conclusion: Infected pancreatic necrosis is linked to high rates of morbidity and mortality. Our study suggests that irrational usage of antibiotics increases the incidence of combined infection, especially with higher rates of multi-drug-resistant infections.

Endoscopic ultrasound-guided vascular interventions: A review (with videos).

Endoscopic ultrasound (EUS) has evolved from a diagnostic to an interventional modality, allowing precise vascular access and therapy. EUS-guided vascular access of the portal vein has received increasing attention in recent years as a diagnostic and therapeutic tool. EUS-guided portal pressure gradient directly measures the hepatic vein portal pressure gradient and is crucial for understanding of liver function and prognostication of liver disease. EUS facilitates the sampling of portal venous blood to obtain circulating tumor cells (CTCs) in pancreatobiliary malignancies. This technique aids in the diagnosis and staging of cancers. EUS-guided interventions have a substantial potential for diagnosing portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma. EUS-guided coil and glue embolization have higher efficacy for the treatment of gastric varices than direct endoscopic glue. Pseudoaneurysm (PsA), a rare vascular complication of acute and chronic pancreatitis, is typically managed with interventional radiology (IR)-guided embolization and surgery. EUS is increasingly used in specialized centers for non-variceal gastrointestinal bleeding, particularly for pseudoaneurysm-related bleeding. There is limited data on EUS-guided intervention for bleeding ectopic varices, rectal varices and Dieulafoy lesions, but it is becoming more widely accepted. In this extensive review, we evaluated both current and potential future applications of EUS-guided vascular interventions, including EUS-guided gastric variceal bleed therapy, rectal and ectopic varices, pseudoaneurysmal bleeding, splenic artery embolization, portal pressure gradient measurement, portal vein sampling for CTCs, fine needle aspiration of PVTT, intrahepatic portosystemic shunt placement, liver tumor ablation and EUS-guided cardiac intervention.

Withered branch-like changes of intrahepatic bile ducts: a rare complication of acute severe biliary pancreatitis.

Withered branch-like changes of intrahepatic bile ducts: a rare complication of acute severe biliary pancreatitis.

Pancreatic necrosis: a scoping review.

Acute pancreatitis (AP) is a commonly encountered GI diagnosis, accounting for 275,000 hospital admissions annually in the United States alone. Pancreatic necrosis (PN) is the most common complication of AP, and the development of PN is associated with significant morbidity and increased mortality. This expert review evaluates the evidence-based management of symptomatic PN from the era of maximal open pancreatic necrosectomy in the late 1990s though the modern paradigm of minimally invasive and endoscopic interventions. The authors present the retrospective and controlled data behind the "step-up approach" to PN treatment and discuss the application of current society guidance. Evidence based management of PN is characterized by early supportive care, and treatment by minimally invasive intervention when a patient is critically ill or persistently symptomatic. Appropriate choices when intervention is required include percutaneous drainage, minimally invasive surgery, and/or endoscopic treatment. The transition from open maximal necrosectomy to minimally invasive intervention has resulted in improved outcomes for patients, including gains in mortality, significant morbidity, and cost. The ideal precision management strategy for an individual patient remains an area of increasing understanding.

Role of Necrosectomy in Necrotizing Pancreatitis: A Narrative Review.

Necrotizing pancreatitis (NP) is a severe complication of acute pancreatitis, characterized by necrosis of pancreatic and peripancreatic tissues, leading to significant morbidity and mortality. The role of necrosectomy, the surgical removal of necrotic tissue, in the management of NP has evolved over the past few decades, moving from early aggressive surgical intervention to a more conservative and stepwise approach. This narrative review explores the historical perspectives, current practices, and future trends in the role of necrosectomy in NP. Early studies favored open surgical debridement; however, high mortality rates associated with early intervention prompted a shift towards minimally invasive techniques, delayed interventions, and the "step-up approach,"combining percutaneous drainage with minimally invasive surgery. We also review the indications for surgery, optimal timing, and various techniques, including video-assisted retroperitoneal debridement and endoscopic transluminal necrosectomy. The review highlights the benefits of these strategies in reducing complications, improving patient outcomes, and minimizing hospital stays. Ongoing research into patient selection, timing, and procedural refinement will continue to shape the role of necrosectomy in NP management. Understanding the evolving role of necrosectomy is crucial for optimizing care and reducing the burden of this life-threatening condition.

Mesenteric thrombosis: An unusual complication of severe acute pancreatitis—Report of two cases

AbstractThe incidence of acute pancreatitis is 34 per 100 000 people in the general population and is on the rise. Approximately 15% to 20% of all patients experience severe pancreatitis, with a mortality rate nearing 20%. This condition is often linked to vascular complications, although mesenteric thrombosis is a rare presentation. We present two cases of severe acute pancreatitis resulting in multiple organ failure. Histopathological examination revealed acute hemorrhagic pancreatitis with necrosis and mesenteric thrombosis in both cases. Mesenteric thrombosis, though uncommon, is a serious complication with atypical symptoms and high mortality rates. Vascular complications in severe acute pancreatitis should not be overlooked. This case report underscores the significance of recognizing such rare complications and the need for comprehensive consideration in clinical assessments.

Rare complications of acute pancreatitis: Clinical cases

Background. Acute pancreatitis is recognized as a common disease, occasionally accompanied by the development of local complications that require surgical debridement. Rare complications of pancreatitis may occur in clinical practice, which is one of the reasons for their untimely diagnosis and treatment. Pancreaticopleural fistula and high small bowel obstruction develop in less than 1% of acute pancreatitis cases. Therefore, possible options for management of these complications are considered valuable. Description of clinical cases. The clinical examples, provided in the present paper, describe pancreaticopleural fistula and high small bowel obstruction that develop against the peripancreatic mass in the abdominal cavity. Patient K., 44, was hospitalized to the Regional Clinical Hospital of Emergency Medical Care, Krasnodar Krai, and preliminary diagnosed with bilateral hydrothorax and type II respiratory failure; pleural puncture was performed. Following the extended examination, a clinical diagnosis was made as follows: “Acute necrotic pancreatitis spreading to a pancreatic tail cyst. Reactive double pleurisy”. The postoperative period was indicated with repeated recurrence of right hydrothorax, and pancreaticopleural fistula (diagnosed by measuring amylase activity in the brown fluid effused from the right pleural cavity, which appeared to be 41216 IU/l (not normally determined)). The right pleural cavity and pseudocyst of the pancreatic tail were drained, resulting in obliteration of the pancreatbcopleural fistula. Patient V., 50, was hospitalized and transferred to the surgical department of the Regional Clinical Hospital No. 2, Krasnodar Krai, and diagnosed with “pancreonecrosis, extensive purulent-necrotic peripancreatitis.” The patient underwent puncture-drainage treatment. The postoperative period was complicated by acute small bowel obstruction. Surgical treatment involved Braun enteroesterostomy. The patient recovered. Conclusion. Pancreaticopleural fistula refers to a rare complication of acute pancreatitis, manifested by hydrothorax. Its diagnosis is based on the determination of amylase activity in the effusion. Drainage of the pleural cavity and pancreatic pseudocyst contributes to obliteration of the fistula. The intestinal obstruction, another complication of pancreatitis, requires open surgical treatment when a conservative therapy appears ineffective.

The Surgical Management of Pancreatic Pseudocysts: A Narrative Review.

Pancreatic pseudocysts, commonly arising as a complication of acute or chronic pancreatitis, present a significant clinical challenge. This narrative review explores the surgical management of pancreatic pseudocysts, emphasizing advancements, techniques, and outcomes. We examine the indications for surgical intervention, including symptomatic pseudocysts, complications such as infection or hemorrhage, and pseudocysts resistant to conservative treatment. Various surgical approaches are discussed, including open surgery, laparoscopic techniques, and endoscopic interventions. The review highlights the evolution of surgical strategies, from traditional cystogastrostomy to minimally invasive methods, and assesses their efficacy and safety. Additionally, we address patient selection criteria, preoperative assessment, and postoperative care. By synthesizing current evidence and clinical experiences, this review aims to provide a comprehensive overview of the best practices in the surgical management of pancreatic pseudocysts, offering valuable insights for clinicians in optimizing patient outcomes.

Introduction to the issue: acute pancreatitis and related metabolic complications.

Introduction to the issue: acute pancreatitis and related metabolic complications.

The Role of Red Cell Distribution Width (RDW), RDW/Platelet Ratio, and Mean Platelet Volume as Prognostic Markers in Acute Pancreatitis Severity and Complications Based on the Bedside Index for Severity in Acute Pancreatitis Score.

Background Acute pancreatitis (AP) is a condition with various etiological factors, marked by the sudden onset of inflammation in the pancreatic tissue. Predicting the severity and potential mortality of AP involves analyzing clinical data alongside laboratory tests and imaging. Among several grading methods with strong predictive capabilities for illness severity and mortality, the Bedside Index for Severity in Acute Pancreatitis (BISAP) score is notable. This study aims to explore the potential role of laboratory markers, specifically red cell distribution width (RDW), RDW/platelet (PLT) ratio, and mean platelet volume (MPV), in predicting disease severity, with patients being stratified according to the BISAP scoring system. Materials and methods This research included 161 patients hospitalized at Cantonal Hospital Zenica in Zenica, Bosnia and Herzegovina, with a diagnosis of AP. The BISAP score was determined based on laboratory and radiological analyses. This score was used to evaluate potential correlations between laboratory findings such as RDW, RDW/PLT ratio, and MPV. Results The age range was significantly higher in patients with BISAP scores ≥3 (68 years, 64-76) compared to those with BISAP scores <3 (59.5 years, 42.75-69) (p = 0.000). RDW values were also significantly higher in patients with BISAP scores ≥3 (15.6%, 14-16.9) compared to those with BISAP scores <3 (13.5%, 13-14.1) (p = 0.000). Hospital stay duration was significantly longer for patients with BISAP scores ≥3 (9 days, 6-11) compared to those with BISAP scores <3 (5 days, 5-7) (p = 0.000). Additionally, the RDW/PLT ratio was significantly lower in patients with BISAP scores <3 (0.063 ± 0.02) compared to those with BISAP scores ≥3 (0.09 ± 0.059) (p = 0.012). Conclusion Our results indicate a significant difference in RDW/PLT ratios between patient severity groups based on BISAP scores (scores <3 vs. ≥3). This suggests that the RDW/PLT ratio may serve as a useful predictor for assessing the severity of AP. However, further research is needed to explore the full potential of the RDW/PLT ratio in evaluating AP patients.

Celiac disease is associated with increased risk of deep vein thrombosis and hypotensive shock in patients admitted with acute pancreatitis.

Celiac disease (CD) was shown to be associated with increased risk of developing acute pancreatitis (AP). There is a paucity of literature critically analyzing the association of CD with AP outcomes. We aimed to evaluate the impact of CD on outcomes and complications of AP in recent years. A population-based analysis was performed using the National Inpatient Sample (NIS) between 2016 and 2019. Multivariable logistic regression was conducted to identify the independent impact of CD on AP outcomes while controlling for demographics and comorbidities and all patients refined diagnosis-related groups (APR-DRG) risk of severity subclass. From 2016 to 2019, a total of 2 253 730 inpatients with AP were identified, of which 4640 (0.2%) had CD. On multivariable analysis, while controlling for demographics, comorbidities, and severity of illness, CD patients had significantly decreased odds for mortality (OR = 0.387), pseudocyst formation (OR = 0.786), sepsis (OR = 0.707), respiratory failure (OR = 0.806), acute kidney injury (AKI) (OR = 0.804), and myocardial infarction (OR = 0.217), (P < 0.05). However, CD patients were at significantly increased odds for deep vein thrombosis (DVT) (OR = 2.240) and hypotensive shock (OR = 1.718) (P < 0.05). Patients with CD had shorter lengths of stay by 0.4 days and lower total charges by $12 690. Our nationwide study evaluating AP outcomes in patients with CD suggests that patients with CD admitted for AP tend to have better mortality and several other outcomes compared to non-CD patients. We also show that CD patients admitted for AP have a greater risk for DVT and hypotensive shock. Future studies are warranted to validate the revealed findings in CD patients admitted for AP.

Acute pancreatitis and computed tomography: Interest of portal venous phase alone in the initial phase.

There are no guidelines in the literature for the use of a computed tomography (CT) protocol in the initial phase of acute pancreatitis (AP). To evaluate the contribution of single portal venous phase CT compared to triple-phase CT protocol, performed in the initial phase of AP for severity assessment. In this retrospective study, a total of 175 patients with acute pancreatitis who underwent initial triple-phase CT protocol (non-contrast, arterial phase, and portal venous phase) between D3 and D7 after the onset of symptoms were included. Analysis of AP severity and complications was independently assessed by two readers using three validated CT severity scores (CTSI, mCTSI, EPIC). All scores were applied to the triple-phase CT protocol and compared to the single portal venous phase. Inter-observer analyses were also performed. No significant difference whatever the severity score was observed after analysis of the single portal venous phase compared with the triple-phase CT protocol (interstitial edematous pancreatitis: CTSI: 2 vs. 2, mCTSI: 2 vs. 2, EPIC: 1 vs. 1; necrotizing pancreatitis: CTSI: 6 vs. 6, mCTSI: 8 vs. 8, EPIC: 5 vs. 5). Inter-observer agreement was excellent (ICC = 0.96-0.99), whatever the severity score. A triple-phase CT protocol performed at the initial phase of AP was no better than a single portal venous for assessing the severity of complications and could lead to a 63% reduction in irradiation.

Evaluation of the quality of electrochemical study in the diagnosis of infection of pancreatic cysts

The formation of pancreatic cysts is a serious complication of acute pancreatitis, chronic pancreatitis and pancreatic injuries. Joulemetry is an integral method for evaluating the electrochemical properties of biological objects. To date, this method has not been used in the study of the electrochemical properties of the contents of pancreatic cysts. The purpose of this study was to evaluate the effectiveness of electrochemical analysis in the detection of infection in the contents of necrotic pancreatic cysts. An electrochemical study of contents of necrotic pancreatic cysts carried out on 106 patients. Group 1 included 84 patients without signs of infection of pancreatic cysts; group 2 included 22 patients with signs of infection of pancreatic cysts. The electrochemical study was conducted as follows: 10 ml of the contents of a pancreatic cyst was injected into a liquid ˛ow sensor of a joule meter, where it was exposed to a electrical current for a short period of time. The resulting data was analyzed using a diagnostic research complex. During the study of the electrochemical properties of the contents of postnecrotic pancreatic cysts by using joulemetry, it was revealed that the current work in patients of group 1 ranged from 0.92 to 18.31 mkJ (on average 5.86±5.02 mkJ), in patients of group 2 – from 19.01 to 26.3 mkJ (on average 22.32±1.92 mkJ). When evaluating the quality of the joulemetric study in determining the early signs of in˛ammation of the contents of postnecrotic pancreatic cysts, it was proved that the threshold differential diagnostic value of 19.1 mkJ provides 81.8% sensitivity of the proposed method and 80.7% specificity (AUC = 91.3) with a statistically signi˝cant difference in current work (p &lt; 0.001).

Comprehensive Review of Surgical and Radiological Management of Hemorrhagic Pancreatitis: Current Strategies and Outcomes.

Hemorrhagic pancreatitis, a severe complication of acute and chronic pancreatitis, involves bleeding due to vascular disruptions. This condition presents significant clinical challenges and is associated with high morbidity and mortality. The bleeding can result from arterial or venous complications, often exacerbated by inflammatory and enzymatic damage to blood vessels within the pancreas. Patients with hemorrhagic pancreatitis may experience symptoms such as abdominal pain, nausea, vomiting, and gastrointestinal bleeding. Diagnostic imaging, including CT and MRI, is crucial in identifying the source of bleeding and guiding treatment decisions. Management strategies have evolved over the past two decades, shifting from purely surgical approaches to including interventional radiology techniques. Surgical intervention is often reserved for hemodynamically unstable patients or those with large pseudoaneurysms, offering definitive treatment but carrying higher risks of complications. Endovascular techniques, such as transcatheter embolization, provide a less invasive alternative with high success rates and shorter recovery times, though rebleeding may occur. Treatment choice depends on various factors, including the patient's stability, the size and location of the bleeding, and the availability of specialized expertise. Overall, the management of hemorrhagic pancreatitis requires a multidisciplinary approach, combining surgical and radiological techniques to optimize patient outcomes and reduce the risk of mortality. Long-term follow-up is essential to monitor for recurrent disease and manage the metabolic consequences of pancreatic insufficiency.

Beyond the revised atlanta classification: a comprehensive review of the imaging assessment of acute pancreatitis and its complications.

While the Revised Atlanta Classification outlines the primary complications of acute pancreatitis, it is crucial to recognize additional factors that contribute to morbidity and mortality associated with acute pancreatitis. In this review, we discuss the imaging-based classification and staging of acute pancreatitis as described by the Revised Atlanta Classification, but also provide a comprehensive understanding of the pancreatic anatomy and its relation to surrounding structures, which is essential for imaging-based assessment of both acute pancreatitis and its complications. We further extend the discussion beyond common complications such as pseudocysts and walled-off necrosis to include lesser-known but significant complications such as peripancreatic infection, disconnected ductal disconnection syndrome, thrombosis, hemorrhage, and gastrointestinal complications. Additionally, illustrative examples are presented to highlight relevant points pertaining to real-life imaging assessment of acute pancreatitis and its complications.