Revision 12 for 'Necrotizing pancreatitis'

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Necrotizing pancreatitis

Necrotizing pancreatitis (NP) represents the severe form of pancreatitis. It is generally considered a subtype of acute pancreatitis as necrosis usually tends to occurs early, (within the first 24-48 hours) but can also rarely occur with subacute forms.

A key feature is a significant amount of pancreatic and/or peripancreatic tissue necrosis associated with pancreatitis.

Epidemiology

Around 5-10% of patients with interstitial edematous pancreatitis (i.e. uncomplicated acute pancreatitis) will develop necrosis 5

Pathology

NP can become infected, more commonly after the first week. 

Radiographic features

NP presents most commonly as necrosis affecting both the pancreas and peripancreatic tissues. Rarely it will affect only the peripancreatic tissues or pancreas in isolation 5.

CT

Areas of necrosis are seen as non-enhancing low attenuating regions within the pancreas, but observed if a dual phase pancreatic study is performed. Foci of gas may also be present in more extreme cases; extra-luminal gas is highly suggestive of superimposed infection. 

Treatment and prognosis

The presence of necrosis implies a poorer prognosis with mortality rates reported up to 14% 3.

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