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Contempo Updates | Clinician's Corner

Severe Acute Pancreatitis

Vege Santhi Swaroop, MD; Suresh T. Chari, MD; Jonathan E. Clain, MD
JAMA. 2004;291(23):2865-2868. doi:10.1001/jama.291.23.2865.
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In the United States, of the approximately 210 000 patients admitted to hospitals each year with acute pancreatitis,1 about 20% have severe acute pancreatitis (SAP), and primary care physicians and internists are often the first clinicians to care for these patients. In contrast to mild acute pancreatitis, which has a mortality rate of less than 1%,2 the death rate for SAP is much higher: 10% with sterile and 25% with infected pancreatic necrosis.3 Hospitalization for patients with SAP may extend beyond 2 weeks and frequently involves an intensive care unit (ICU) stay.

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Figure. Computed Tomography and Magnetic Resonance Imaging Appearance of Pancreatitis
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Panels A through E (left), computed tomography (CT) images; panel E (right), magnetic resonance imaging (MRI). A, Mild acute pancreatitis showing normal enhancement of the body of pancreas (arrowheads) after intravenous contrast. B, Severe acute pancreatitis showing pancreatic necrosis with areas of the pancreas not enhancing (yellow arrowhead) after contrast administration compared with areas that are normally perfused (black arrowhead). C, Pseudocyst of the pancreas (arrowheads) with clear-appearing fluid within the collection near the pancreas. D, Pancreatic abscess with presence of gas (arrowhead) inside the cavity. E, Pancreatic necrosis (necrotic collection), which appears on CT scan as a clear fluid collection (yellow arrowheads). The same collection on MRI shows areas of necrotic debris (black arrowhead) not observed on CT scan, a distinction that has prognostic and therapeutic implications.

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