Contrast Enhanced Computed Tomographic Evaluation of Vascular Complications of Pancreatitis
Keywords:Vascular complications, MCTSI score, acute pancreatitis, Splanchnic vein thrombosis
Aim: This study is designed to assess the role of Contrast Enhanced Computed Tomography in the evaluation of Vascular Complications of Pancreatitis. Method: Hospital based prospective study in 150 patients with pancreatitis based on clinical and laboratory findings. CT scan Imaging was done with 128 slice GE Optima CT machine. Results: Out of the 150 pancreatitis cases, 87.3% are males. Acute pancreatitis (81, 54%) is the major morphologic type. Majority of the AP cases are of interstitial edematous type (55, 67.9%). Mild AP is found in 25.9%, Moderate AP constitutes 48.1% and Severe AP in 25.9% cases. Vascular complications observed as 26.67% in the age range of 41 to 50 years. Acute necrotizing type is the leading cause. Vascular complications is highest with severe AP (85.7%) with MCTSI scores of 8 and 10. In our study, there is high association of vascular complications with necrotizing pancreatitis as well. In 110 vascular uncomplicated cases, meticulous analysis reveals indirectly that vascular complications are less associated with mild and moderate acute pancreatitis. 80% are constituted by venous complications, 15% accounted to arterial complications. Both arterial and venous complications constitute to 5%. Splanchnic vein thrombosis is the most common venous complication followed by isolated portal vein and isolated splenic vein thrombosis. Rare cases of right hepatic artery pseudoaneurysm, splenic artery pseudoaneurysm, co-existing thrombus and pseudoaneurysm in superior mesenteric artery, left renal vein thrombosis, inferior mesenteric vein thrombosis have been reported. An exceptional case of thrombosis of splenic vein, portal vein, superior mesenteric vein, left renal vein, inferior vena cava and right atrium have been reported. Another notable case is pulsatile pseudocyst. Vascular complications significantly affects the patient’s outcome in terms of various outcome parameters. The average length of hospitalization for vascular complicated cases is 16-20 days and for vascular uncomplicated cases, it is 1-5 days. Mortality rate in the study with vascular complications is 2.5%. Conclusion: Our study also yielded a statistically highly significant result of vascular complications being associated with higher MCTSI score. The MCTSI score increases, the prevalence of vascular complications increases and therefore significantly affects the patient’s outcome in terms of various outcome parameters.
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Copyright (c) 2021 Keerthika Chinta, Pradeep Tavva, Rishi Papanaidu, Priyanka Chinta
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