CT Manifestation and Clinical Significance of Gastrointestinal Tract Involvement in Acute Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Guangwen ¹ , SONG Bin ¹ , XU Juan ² , LIU Xijiao ¹ , WU Bi ¹

1.Department of Radiology, West China Hospital, Sichuan University， Chengdu 610041, China;;
2.Department of Radiology, The Fourth People’s Hospital of Sichuan Province, Chengdu 610014, China;

Corresponding author：

Keywords：

Acute pancreatitis; gastrointestinal tract involvement; Severity; Tomography/X-ray computed; Clinical significance

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Objective To investigate the CT manifestation and clinical significance of the gastrointestinal tract involvement in acute pancreatitis (AP).
Methods Two hundreds CT scans in 131 patients with acute pancreatitis between Jan. 1, 2009 and Jun. 30, 2009 were included into the study. Two radiologists analyzed the images retrospectively, paying attention to the CT features of the gastrointestinal tract involvement, such as the style, distribution, and so on. The correlation between gastrointestinal tract involvement and CT severity index, clinical severity grading, and turnover of acute pancreatitis were studied using a SPSS 14.0 for windows statistics software.
Results The CT images in 109 (83.2%) patients showed gastrointestinal tract involvement, which distributing mainly stomach, duodenum, jejunum, and transverse colon, and showing mainly the gastrointestinal tract wall thickening and distension. The gastrointestinal tract involvement had positive correlation with CT severity index, clinical severity grading, and turnover of acute pancreatitis (r=0.689， P=0.000; r=0.584， P=0.000; r=0.346， P=0.000).
Conclusions The gastrointestinal tract involvement is common complication in acute pancreatitis and concerns with severity and prognosis of the disease. As other extrapancreatic organs involvement, the gastrointestinal tract involvement has important value for severity assessment, prognosis evaluation, and therapeutic effect monitoring of acute pancreatitis.

Citation： CHEN Guangwen ,SONG Bin,XU Juan,LIU Xijiao,WU Bi. CT Manifestation and Clinical Significance of Gastrointestinal Tract Involvement in Acute Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(5): 508-513. doi: Copy

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8.	Balthazar EJ, Ranson JH, Naidich DP, et al. Acute pancreatitis: prognostic value of CT[J]. Radiology, 1985; 156（3）: 767-772.
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13.	Ahualli J. The Target Sign: bowel wall [J]. Radiology，2005; 234（2）: 549-550.
14.	Furukawa A, Saotome T, Yamasaki M, et al. Cross-sectional imaging in Crohn disease[J]. Radiographics， 2004; 24（3）: 689-702.
15.	Lalani TA, Kanne JP, Hatfield GA, et al. Imaging findings in systemic lupus erythematosus [J]. Radiographics， 2004; 24(4): 1069-1086.
16.	陈光文, 宋彬, 吴苾. 非肿瘤性肠壁增厚的多层螺旋CT表现与病理基础[J]. 中国临床医学影像杂志, 2009; 20(8): 615-619.
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18.	Boudiaf M, Soyer P, Terem C, et al. CT evaluation of small bowel obstruction [J]. Radiographics, 2001; 21(3): 613-624.
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24.	Mortele KJ, Wiesner W, Intriere L, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome [J]. AJR Am J Roentgenol, 2004; 183（5）: 1261-1265.

1. Casas JD, Díaz R, Valderas G, et al. Prognostic value of CT in the early assessment of patients with acute pancreatitis[J]. AJR Am J Roentgenol, 2004; 182（3）: 569-574.
2. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation[J]. Radiology, 2002; 223（3）: 603-613.
3. 闵鹏秋, 严志汉, 杨恒选, 等. 急性胰腺炎累及肾旁后间隙的螺旋CT表现及其解剖基础 [J]. 中华放射学杂志, 2005; 39(4): 379-382.
4. Karahan OI, Dodd GD 3rd, Chintapalli KN, et al. Gastrointestinal wall thickening in patients with cirrhosis: frequency and patterns at contrast-enhanced CT [J]. Radiology, 2000; 215（1）: 103-107.
5. Macari M, Balthazar EJ. CT of bowel wall thinking: significance and pitfalls of interpretation [J]. AJR Am J Roentgenol, 2001; 176（5）: 1105-1116.
6. d’Almeida M, Jose J, Oneto J, et al. Bowel wall thickening in children: CT findings [J]. Radiographics, 2008; 28（3）: 727-746.
7. Wittenberg J, Harisinghani MG, Jhaveri K, et al. Algorithmic approach to CT diagnosis of the abnormal bowel wall [J]. Radiographics， 2002; 22（5）: 1093-1109.
8. Balthazar EJ, Ranson JH, Naidich DP, et al. Acute pancreatitis: prognostic value of CT[J]. Radiology, 1985; 156（3）: 767-772.
9. 张瑾, 宋彬, 严志汉, 等. 急性胰腺炎腹壁受累的CT表现及临床意义 [J]. 四川大学学报（医学版）, 2003; 34(4): 766-769.
10. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992 [J]. Arch Surg, 1993; 128(5): 586-590.
11. 严志汉, 闵鹏秋, 刘再毅, 等. 急性胰腺炎累及肾周间隙的CT表现与临床严重程度的相关性 [J]. 温州医学院学报, 2004; 34(1): 17-19.
12. 陈光文, 宋彬, 吴苾. 肠壁增厚的CT表现及诊断意义 [J]. 中国普外基础与临床杂志， 2008; 15(12): 943-949.
13. Ahualli J. The Target Sign: bowel wall [J]. Radiology，2005; 234（2）: 549-550.
14. Furukawa A, Saotome T, Yamasaki M, et al. Cross-sectional imaging in Crohn disease[J]. Radiographics， 2004; 24（3）: 689-702.
15. Lalani TA, Kanne JP, Hatfield GA, et al. Imaging findings in systemic lupus erythematosus [J]. Radiographics， 2004; 24(4): 1069-1086.
16. 陈光文, 宋彬, 吴苾. 非肿瘤性肠壁增厚的多层螺旋CT表现与病理基础[J]. 中国临床医学影像杂志, 2009; 20(8): 615-619.
17. Guingrich JA, Kuhiman JE. Colonic wall thickening in patients with cirrhosis: CT findings and clinical implications [J]. AJR Am J Roentgenol, 1999; 172(4): 919-924.
18. Boudiaf M, Soyer P, Terem C, et al. CT evaluation of small bowel obstruction [J]. Radiographics, 2001; 21(3): 613-624.
19. Bodily KD, Fletcher JG, Solem GA, et al. Crohn Disease: mural attenuation and thickness at contrast-enhanced CT Enterography-correlation with endoscopic and histologic findings of inflammation [J]. Radiology, 2006; 238(2): 505-516.
20. Mackalski BA, Bernstein CN. New diagnostic imaging tools for inflammatory bowel disease [J]. Gut, 2006; 55(5): 733-741.
21. Horton KM, Fishman EK. Multi-detector row CT of mesenteric ischemia: can it be done? [J]. Radiographics， 2001; 21(6): 1463-1473.
22. Kalantari BN, Mortelé KJ, Cantisani V, et al. CT features with pathologic correlation of acute gastrointestinal graft-versus-host disease after bone marrow transplantation in adults [J]. AJR Am J Roentgenol, 2003; 181(6): 1621-1625.
23. Epelman M, Daneman A, Navarro OM, et al. Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation [J]. Radiographics， 2007; 27(2): 285-305.
24. Mortele KJ, Wiesner W, Intriere L, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome [J]. AJR Am J Roentgenol, 2004; 183（5）: 1261-1265.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

CT Manifestation and Clinical Significance of Gastrointestinal Tract Involvement in Acute Pancreatitis

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