Late development of pancreas necrosis during acute pancreatitis: An underestimated phenomenon associated with high morbidity and mortality

OBJECTIVE: The purpose of this study is to assess the prognostic significance of late parenchymal pancreas necrosis as observed on serial contrast-enhanced computed tomographic (CT) scan. METHODS: Eighty-four patients with acute necrotizing pancreatitis were included. All initial CT scans were examined on complete contrast enhancement of the pancreas parenchyma (viable pancreas) or incomplete enhancement indicating parenchymal necrosis of the pancreas (PN).Secondly, all serial CT scans were evaluated to investigate whether late PN occurred in the group with a viable pancreas on initial CT scan. Characteristics of this group were evaluated. RESULTS: Thirteen patients showed signs of PN on initial CT scan. Late necrosis occurred in 5 patients. The average hospital stay in this subgroup was 46.7 days; complication rate, 100%; and mortality, 40%.A significant difference in hospital stay (average of 45.1 days vs 24.3 days; P = 0.003), complication rate (72% vs 33%; P = 0.006), and mortality (28% vs 6%; P = 0.019) was found when the group with eventual PN was compared with the group with no signs of PN (on initial and serial CT). CONCLUSIONS: This study shows a significant increase in hospital stay, complication rate, and mortality when eventual PN is shown on CT scan. Patients with late PN especially have a poor prognosis.

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